Drastic magnetic-field-induced chiral current order and emergent current-bond-field interplay in kagome metals

In kagome metals, the chiral current order parameter [Formula: see text] with time-reversal-symmetry-breaking is the source of various exotic electronic states, while the method of controlling the current order and its interplay with the star-of-David bond order [Formula: see text] are still unsolved. Here, we reveal that tiny uniform orbital magnetization [Formula: see text] is induced by the chiral current order, and its magnitude is prominently enlarged under the presence of the bond order. Importantly, we derive the magnetic-field ([Formula: see text])-induced Ginzburg-Landau (GL) free energy expression [Formula: see text], which enables us to elucidate the field-induced current-bond phase transitions in kagome metals. The emergent current-bond-[Formula: see text] trilinear coupling term in the free energy, [Formula: see text], naturally explains the characteristic magnetic-field sensitive electronic states in kagome metals, such as the field-induced current order and the strong interplay between the bond and current orders. The GL coefficients of [Formula: see text] derived from the realistic multiorbital model are appropriate to explain various experiments. Furthermore, we discuss the field-induced loop current orders in the square lattice models that have been studied in cuprate superconductors.

Charge-loop current order and Z3 nematicity mediated by bond order fluctuations in kagome metals

Recent experiments on geometrically frustrated kagome metal AV3Sb5 (A = K, Rb, Cs) have revealed the emergence of the charge loop current (cLC) order near the bond order (BO) phase. However, the origin of the cLC and its interplay with other phases have been uncovered. Here, we propose a novel mechanism of the cLC state, by focusing on the BO phase common in kagome metals. The BO fluctuations in kagome metals, which emerges due to the Coulomb interaction and the electron-phonon coupling, mediate the odd-parity particle-hole condensation that gives rise to the topological current order. Furthermore, the predicted cLC+BO phase gives rise to the Z3-nematic state in addition to the giant anomalous Hall effect. The present theory predicts the close relationship between the cLC, the BO, and the nematicity, which is significant to understand the cascade of quantum electron states in kagome metals. The present scenario provides a natural understanding.

Mechanism of exotic density-wave and beyond-Migdal unconventional superconductivity in kagome metal AV3Sb5 (A = K, Rb, Cs)

Exotic quantum phase transitions in metals, such as the electronic nematic state, have been discovered one after another and found to be universal now. The emergence of unconventional density-wave (DW) order in frustrated kagome metal AV3Sb5 and its interplay with exotic superconductivity attract increasing attention. We find that the DW in kagome metal is the bond order, because the sizable intersite attraction is caused by the quantum interference among paramagnons. This mechanism is important in kagome metals because the geometrical frustration prohibits the freezing of paramagnons. In addition, we uncover that moderate bond-order fluctuations mediate sizable pairing glue, and this mechanism gives rise to both singlet s-wave and triplet p-wave superconductivity. Furthermore, characteristic pressure-induced phase transitions in CsV3Cb5 are naturally understood by the present theory. Thus, both the exotic density wave and the superconductivity in geometrically frustrated kagome metals are explained by the quantum interference mechanism.

Pressure-induced reconstitution of Fermi surfaces and spin fluctuations in S-substituted FeSe

FeSe is a unique high-\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$T_c$$\end{document}Tc iron-based superconductor in which nematicity, superconductivity, and magnetism are entangled with each other in the P-T phase diagram. We performed \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$^{77}$$\end{document}77Se-nuclear magnetic resonance measurements under pressures of up to 3.9 GPa on 12% S-substituted FeSe, in which the complex overlap between the nematicity and magnetism are resolved. A pressure-induced Lifshitz transition was observed at 1.0 GPa as an anomaly of the density of states and as double superconducting (SC) domes accompanied by different types of antiferromagnetic (AF) fluctuations. The low-\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$T_{\mathrm{c}}$$\end{document}Tc SC dome below 1 GPa is accompanied by strong AF fluctuations, whereas the high-\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$T_{\mathrm{c}}$$\end{document}Tc SC dome develops above 1 GPa, where AF fluctuations are fairly weak. These results suggest the importance of the \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$d_{xy}$$\end{document}dxy orbital and its intra-orbital coupling for the high-\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$T_{\mathrm{c}}$$\end{document}Tc superconductivity.

Abrupt change of the superconducting gap structure at the nematic critical point in FeSe1-xSx

The emergence of the nematic electronic state that breaks rotational symmetry is one of the most fascinating properties of the iron-based superconductors, and has relevance to cuprates as well. FeSe has a unique ground state in which superconductivity coexists with a nematic order without long-range magnetic ordering, providing a significant opportunity to investigate the role of nematicity in the superconducting pairing interaction. Here, to reveal how the superconducting gap evolves with nematicity, we measure the thermal conductivity and specific heat of FeSe1 - x S x , in which the nematicity is suppressed by isoelectronic sulfur substitution and a nematic critical point (NCP) appears at [Formula: see text] We find that, in the whole nematic regime ([Formula: see text]), the field dependence of two quantities consistently shows two-gap behavior; one gap is small but highly anisotropic with deep minima or line nodes, and the other is larger and more isotropic. In stark contrast, in the tetragonal regime ([Formula: see text]), the larger gap becomes strongly anisotropic, demonstrating an abrupt change in the superconducting gap structure at the NCP. Near the NCP, charge fluctuations of [Formula: see text] and [Formula: see text] orbitals are enhanced equally in the tetragonal side, whereas they develop differently in the orthorhombic side. Our observation therefore directly implies that the orbital-dependent nature of the nematic fluctuations has a strong impact on the superconducting gap structure and hence on the pairing interaction.

Robotic-assisted multivisceral resection for rectal cancer: short-term outcomes at a single center

BACKGROUND

The safety and feasibility of robotic-assisted multivisceral resection for locally advanced rectal cancer remain unclear. The aim of this study was to assess the short-term outcomes of this procedure at our institution.

METHODS

From December 2011 to December 2016, patients who underwent robotic-assisted multivisceral resection for rectal cancer were investigated. Patient demographics, treatment characteristics, perioperative outcomes, and pathological results were evaluated retrospectively.

RESULTS

There were 31 patients; 17 men (54.8%) and 14 women (45.2%), with a median age of 65 years (range 40-82 years). Twenty-one patients (67.7%) had a cT4 tumor, 9 patients (29.0%) had a pT4b tumor, and all patients except one (96.8%) underwent complete resection of the primary tumor with negative resection margins. Eleven patients (35.5%) received neoadjuvant chemoradiation. The most commonly resected organ was the vaginal wall (n = 12, 38.7%), followed by the prostate (n = 10, 32.3%). Lateral lymph node dissection was performed in 20 patients (64.5%). The median operative time was 394 min (range 189-549 min), and the median blood loss was 41 mL (range 0-502 mL). None of the patients received intraoperative blood transfusions or required conversion to open. Overall, postoperative complications occurred in 11 patients (35.5%). The most frequent complication was urinary retention (n = 5, 16.1%), and none of the patients developed serious complications classified as Clavien-Dindo grades III-V.

CONCLUSIONS

Robotic-assisted multivisceral resection for rectal cancer is safe and technically feasible.

Sign-Reversing Orbital Polarization in the Nematic Phase of FeSe due to the C_{2} Symmetry Breaking in the Self-Energy

To understand the nematicity in Fe-based superconductors, nontrivial k dependence of the orbital polarization [ΔE_{xz}(k), ΔE_{yz}(k)] in the nematic phase, such as the sign reversal of the orbital splitting between Γ and X, Y points in FeSe, provides significant information. To solve this problem, we study the spontaneous symmetry breaking with respect to the orbital polarization and spin susceptibility self-consistently. In FeSe, due to the sign-reversing orbital order, the hole and electron pockets are elongated along the k_{y} and k_{x} axes, respectively, consistently with experiments. In addition, an electron pocket splits into two Dirac cone Fermi pockets while increasing the orbital polarization. The orbital order in Fe-based superconductors originates from the strong positive feedback between the nematic orbital order and spin susceptibility.

Linear response theory for shear modulus C66 and Raman quadrupole susceptibility: evidence for nematic orbital fluctuations in Fe-based superconductors

The emergence of the nematic order and fluctuations has been discussed as a central issue in Fe-based superconductors. To clarify the origin of the nematicity, we focus on the shear modulus C(66) and the Raman quadrupole susceptibility χ(x)(2)-y(2))(Raman). Because of the Aslamazov-Larkin vertex correction, the nematic-type orbital fluctuations are induced, and they enhance both 1/C(66) and χ(x(2)-y(2))(Raman) strongly. However, χ(x)(2)-y(2))(Raman) remains finite even at the structure transition temperature T(S), because of the absence of the band Jahn-Teller effect and the Pauli (intraband) contribution, as proved in terms of the linear response theory. The present study clarifies that the origin of the nematicity in Fe-based superconductors is the nematic orbital order and fluctuations.

High-Tc superconductivity near the anion height instability in Fe-based superconductors: analysis of LaFeAsO(1-x)H(x)

The isostructural transition in the tetragonal phase with a sizable change in the anion height, is realized in heavily H-doped LaFeAsO and (La,P) codoped CaFe2As2. In these compounds, the superconductivity with higher Tc (40-50 K) is realized near the isostructural transition. To find the origin of the anion-height instability and the role in realizing the higher-Tc state, we develop the orbital-spin fluctuation theory by including the vertex correction. We analyze LaFeAsO(1-x)H(x) and find that the non-nematic orbital fluctuations, which induce the anion-height instability, are automatically obtained at x∼0.5, in addition to the conventional nematic orbital fluctuations at x∼0. The non-nematic orbital order triggers the isostructural transition, and its fluctuation would be a key ingredient to realize higher-Tc superconductivity of order 50 K.

Detection of antiferromagnetic ordering in heavily doped LaFeAsO(1-x)H(x) pnictide superconductors using nuclear-magnetic-resonance techniques

We studied double superconducting (SC) domes in LaFeAsO(1-x)H(x) by using 75As and 1H nuclear-magnetic-resonance techniques and unexpectedly discovered that a new antiferromagnetic (AF) phase follows the double SC domes on further H doping, forming a symmetric alignment of AF and SC phases in the electronic phase diagram. We demonstrated that the new AF ordering originates from the nesting between electron pockets, unlike the nesting between electron and hole pockets, as seen in the majority of undoped pnictides. The new AF ordering is derived from the features common to high-Tc pnictides; however, it has not been reported so far for other high-Tc pnictides because of their poor electron doping capability.

Pharmacokinetic impact of SLCO1A2 polymorphisms on imatinib disposition in patients with chronic myeloid leukemia

The purpose of this study was to explore the role of the organic anion-transporting polypeptide (OATP) 1A2, which is encoded by SLCO1A2, in the cellular uptake of the Bcr-Abl tyrosine kinase inhibitor imatinib, and the relationship between SLCO1A2 polymorphisms and the pharmacokinetics of imatinib in patients with chronic myeloid leukemia (CML). Imatinib uptake was significantly enhanced in OATP1A2-transfected human embryonic kidney (HEK) 293 cells (P = 0.002). Naringin, an OATP1A2 inhibitor, decreased the transport of imatinib in OATP1A2-transfected HEK293 cells, the human intestinal cell line Caco-2, and K562 CML cells. Linkage disequilibrium was found between the SLCO1A2 -1105G>A and -1032G>A genotypes in 34 CML patients and 100 healthy subjects. Imatinib clearance in CML patients was influenced by the SLCO1A2 -1105G>A/-1032G>A genotype (P = 0.075) and the SLCO1A2 -361GG genotype (P = 0.005). These findings suggest that imatinib is transported into cells by OATP1A2, and that SLCO1A2 polymorphisms significantly affect imatinib pharmacokinetics.

The role of immune cells in brain metastasis of lung cancer cells and neuron-tumor cell interaction

Following any type of brain injury such as lesion, stroke, and tumor/cancer invasion, microglia are rapidly activated and recruited to the site of injury. Microglia is the main immune effector cell population of the central nervous system and control immune cell recruitment. However, the molecular mechanism of brain metastasis and interaction between neuron-glia-tumor cells are poorly understood. Therefore, we established an animal model for brain metastasis using human lung cancer-derived cells (HARA-B) in nude mice. Accumulation of activated microglia was observed around tumor cells depending on the size of metastatic foci and the area of the brain. In vitro study, conditioned medium from primary cultured mouse microglia inhibited the proliferation of tumor cells, while tumor cell-conditioned medium inhibited the proliferation of primary cultured neurons from mouse cortex. Though the responsible factors released from microglia and tumor cells are still under investigation, these studies will contribute to understand the mechanism of cell-cell interaction in the brain and possible therapeutic target for brain metastasis.

[Multilocular thymic cyst]

We describe a case of multilocular thymic cyst with severe acute inflammation. A 23-year-old man was admitted to our hospital with a sudden onset of chest pain and high fever. A computed tomography scan showed multilocular cystic lesion at anterior mediastinum. We resected the tumor with the thymus by median sternotomy. Macroscopically, the mediastinal mass showed thick-walled multiloculated cavities filled with turbid yellow fluid. Histological examination revealed that the tumor was a multilocular thymic cyst which is reported by Suster.

[Tension hemothorax associated with congenital pulmonary arteriovenous fistula]

We describe a case of intrapleural rupture of pulmonary arteriovenous fistula A 37-year-old woman was admitted to our hospital with a sudden onset of right chest pain. A computed tomography scan showed massive pleural effusion and tension hemothorax. Subsequently the patient went into shock. Partial resection of the lung was performed emergently. Pulmonary arteriovenous fistula is often associated with Rendu-Osler-Weber disease (ROW). Because of her brain arteriovenous malformation and family history, we could not exclude the possibility of ROW.

Species-specificity of a panel of prion protein antibodies for the immunohistochemical study of animal and human prion diseases

Monoclonal antibodies to the prion protein (PrP) have been of critical importance in the neuropathological characterization of PrP-related disease in men and animals. To determine the influence of species-specific amino-acid substitutions recognized by monoclonal antibodies, and to investigate the immunohistochemical reactivity of the latter, analyses were carried out on brain sections of cattle with bovine spongiform encephalopathy, sheep with scrapie, mice infected with scrapie, and human beings with Creutzfeldt-Jakob disease (CJD) or Gerstmann-Sträussler-Sheinker disease (GSS). Immunoreactivity varied between the antibodies, probably as the result of differences in the amino-acid sequence of the prion protein in the various species. Some monoclonal antibodies against mouse recombinant PrP gave strong signals with bovine, ovine and human PrP(Sc), in addition to murine PrP(Sc), even though the amino-acid sequences determined by the antibody epitope are not fully identical with the amino-acid sequences proper to the species. On the other hand, in certain regions of the PrP sequence, when the species-specificity of the antibodies is defined by one amino-acid substitution, the antibodies revealed no reactivity with other animal species. In the region corresponding to positions 134-159 of murine PrP, immunohistochemical reactivity or species-specificity recognized by the antibodies may be determined by one amino acid corresponding to position 144 of murine PrP. Not all epitopes recognized by a monoclonal antibody play an important role in antigen-antibody reactions in immunohistochemistry. The presence of the core epitope is therefore vital in understanding antibody binding ability.

Identification and gene expression of the bovine C-type lectin Dectin-1

C-type lectin receptors (CTLR) are cell-surface signalling molecules that recognize a range of highly conserved pathogen molecules and instigate the appropriate immune response. Here, we report the cloning, sequencing, mapping and expression pattern of the bovine C-type lectin domain family 7, member A (CLEC7A; synonyms CLCSF12, Dectin-1). We identified two isoforms, similar to the human system, with a long and short neck. Overall, the organization of the two bovine CLEC7A genes is similar to that of humans and mice. The CLEC7A gene maps on Bos taurus chromosome 5 (BTA5). mRNA transcripts for CLEC7A were detected in bone-marrow cells, monocytes, macrophages and dendritic cells and NK cells, but not in CD4(+) T-cells or CD21(+) B-cells. The increased knowledge of the genomic organization of the bovine CTLR genes may promote our understanding of their evolution and help in the identification of bovine genes underlying disease-resistance traits.

Effusion and solid lymphomas have distinctive gene and protein expression profiles in an animal model of primary effusion lymphoma

Lymphoma usually forms solid tumours in patients, and high expression levels of adhesion molecules are observed in these tumours. However, Kaposi's sarcoma-associated herpesvirus (KSHV)-related primary effusion lymphoma (PEL) does not form solid tumours and adhesion molecule expression is suppressed in the cells. Inoculation of a KSHV-associated PEL cell line into the peritoneal cavity of severe combined immunodeficiency mice resulted in the formation of effusion and solid lymphomas in the peritoneal cavity. Proteomics using two-dimensional difference gel electrophoresis and DNA microarray analyses identified 14 proteins and 105 genes, respectively, whose expression differed significantly between effusion and solid lymphomas. Five genes were identified as having similar expression profiles to that of lymphocyte function-associated antigen 1, an important adhesion molecule in leukocytes. Among these, coronin 1A, an actin-binding protein, was identified as a molecule showing high expression in solid lymphoma by both DNA microarray and proteomics analyses. Western and northern blotting showed that coronin 1A was predominantly expressed in solid lymphomas. Moreover, KSHV-encoded lytic proteins, including viral interleukin-6, were highly expressed in effusion lymphoma compared with solid lymphoma. These data demonstrate that effusion and solid lymphomas possess distinctive gene and protein expression profiles in our mouse model, and suggest that differences in gene and protein expression between effusion and solid lymphomas may be associated with the formation of effusion lymphoma or invasive features of solid lymphoma. Furthermore, the results obtained using this combination of proteomics and DNA microarray analyses indicate that protein synthesis partly reflects, but does not correlate strictly with, mRNA production.

SAGE mRNA expression in advanced-stage lung cancers

AIMS

SAGE and HAGE are recently isolated genes, which were thought to be expressed tumour-specifically, and are potentially coding for tumour-specific antigens recognized by T lymphocytes. The expression of these genes may serve as a useful diagnostic marker in detecting malignant disease. We report the correlation of SAGE and HAGE expression with clinicopathological features in patients with lung cancer who had undergone surgery.

METHODS

Expression of SAGE and HAGE messenger RNA was evaluated by reverse transcription-polymerase chain reaction (RT-PCR) in 102 lung carcinomas and adjacent histological normal lung samples using LightCycler.

RESULTS

SAGE/GAPDH mRNA expression was not significantly different between the tumour of lung cancer tissue (3.777+/-10.802) and normal lung tissue (3.028+/-3.356, p=0.7283). There was no relationship between SAGE gene expression and age, gender or N-status. SAGE/GAPDH expression was significantly higher in stage III-IV lung cancer (6.180+/-16.475) than in stage I lung cancer (1.534+/-2.591, p=0.0393). SAGE/GAPDH expression was also significantly higher in T4 lung cancer (9.183+/-23.117) than in T2 lung cancer (2.676+/-5.943, p=0.0362) and T1 lung cancer (2.373+/-3.433, p=0.0371).

CONCLUSIONS

Detection for SAGE mRNA expression is possible in lung cancer samples. There was no relationship between HAGE gene expression and clinicopathological factor, such that the usefulness of detection for HAGE mRNA expression is limited for lung cancer.

Angioarrestin mRNA expression in early-stage lung cancers

AIMS

Angioarrestin is a recently isolated gene, which has a novel function as an angiogenesis inhibitor. Angiogenesis plays an important role in tumorigenesis. It has been reported that the angioarrestin expression was decreased in lung cancer. We attempted to determine the influence of angioarrestin expression on clinicopathological features in patients with lung cancer who had undergone surgery.

METHODS

Expression of angioarrestin messenger RNA was evaluated by a quantitative reverse transcription-polymerase chain reaction (RT-PCR) in 93 lung carcinomas and adjacent histological normal lung samples using LightCycler.

RESULTS

Angioarrestin/GAPDH mRNA expression was significantly decreased in the tumor of lung cancer tissue (86.676+/-123.505) than in the normal lung tissue (1154.218+/-2003.508, p<0.0001), although only four lung cancer tissues had more than one tumor/normal ratio of angioarrestin/GAPDH mRNA expression. There was no relationship between angioarrestin gene expression and age, gender or T-status. However, decreased angioarrestin/GAPDH expression was especially seen at stage I lung cancer (54.156+/-62.783) when compared to stage II-IV lung cancer (110.315+/-151.359, p=0.0316). Decreased angioarrestin/GAPDH expression was especially seen at N0 lung cancer (56.396+/-69.941) when compared to N2 lung cancer (137.522+/-180.489, p=0.0362).

CONCLUSIONS

The decreased expression of angioarrestin mRNA was the early phase phenomena for tumor progression from lung cancer. Alternatively, loss of antianiogenesis might play a role in oncogenesis for lung cancer.

Carbamazepine-induced hypersensitivity syndrome associated with transient hypogammaglobulinaemia and reactivation of human herpesvirus 6 infection demonstrated by real-time quantitative polymerase chain reaction

Drug-induced hypersensitivity syndrome (HS) is a rare but severe disease with multiorgan failure. Many different precipitating factors have been reported, but the pathophysiology of HS remains unknown. However, the association of the human herpesvirus (HHV) family, particularly of HHV-6, has recently been reported in patients with HS. We report a 14-year-old boy who was diagnosed as having carbamazepine-induced HS based on the clinical course, laboratory data and results of drug-induced lymphocyte stimulation tests. In addition, the reactivation of HHV-6 was demonstrated by real-time quantitative polymerase chain reaction and by significantly increased levels of the specific antibody in his paired sera. Furthermore, transient hypogammaglobulinaemia was detected in the early stage of the disease. In addition, serum levels of interferon-gamma, interleukin (IL)-6, IL-5 and eosinophil cationic protein, which were increased on admission, decreased dramatically after steroid therapy. This is the first report of carbamazepine-induced HS associated with reactivation of HHV-6, transient hypogammaglobulinaemia, increased serum levels of inflammatory cytokines and activated eosinophils. This case might contribute to the understanding of the pathophysiology of HS.

Quantitative assessment of the total myocardial uptake ratio of 123I-BMIPP by using the Ishii-MacIntyre method is useful for predicting cardiac complications in patients with mitochondrial encephalomyopathy or myotonic dystrophy

We evaluated the usefulness of the total myocardial uptake ratio (TMUR) of 15-(p-[123I]iodophenyl)-3(R,S)-methyl-pentadecanoic acid (123I-BMIPP) for predicting cardiac complications in patients with mitochondrial encephalomyopathy or myotonic dystrophy. Six patients with mitochondrial encephalomyopathy, four with myotonic dystrophy, and 10 control subjects were studied. Quantitative assessment of 123I-BMIPP dynamic myocardial imaging was performed, and the TMUR of 123I-BMIPP was calculated according to the Ishii-MacIntyre method. Then, the TMUR was compared in the 10 patients and 10 healthy controls, and all patients were followed for 56.1+/-22.1 months to evaluate cardiac complications. TMUR in patients (2.69+/-0.64) was significantly (P =0.01) lower than that in controls (3.28+/-0.25). Three patients in whom the TMUR value was above 3.00 had no cardiac complications. On the other hand, all patients in whom TMUR was below 3.00 had some kind of cardiac complication during the follow-up period. Two patients showed progressive conduction abnormality and underwent pacemaker implantation, one patient had sick sinus syndrome and underwent pacemaker implantation, another patient showed non-sustained ventricular tachycardia and paroxysmal atrial fibrillation, and four of seven patients, including one with a pacemaker, showed an increased cardiothoracic ratio value over 50%. In conclusion, measurement of the TMUR by the Ishii-MacIntyre method is useful for evaluating the development of cardiac complications in patients with mitochondrial encephalomyopathy or myotonic dystrophy.

Clinical significance of tissue inhibitor of metalloproteinase and matrix metalloproteinase mRNA expression in thymoma

BACKGROUND

Matrix metalloproteinases (MMPs) are proteolytic enzymes which degrade extracellular matrix and basement membrane. There is much evidence that their increased expression is correlated with tumor aggressiveness in various carcinomas. Tissue inhibitor of metalloproteinases (TIMPs) are the specific inhibitors of MMPs. MMPs and TIMPs are considered to play an important role in carcinoma invasion and metastasis. We hypothesized that MMPs and TIMPs also play an important role in thymoma.

MATERIALS AND METHODS

This study included 34 thymoma cases. The mRNA levels of MMP-1, -7, and -9, TIMP-1 and -2, and GAPDH were quantified by real-time polymerase chain reaction using LightCycler. We also performed immunohistochemistry for TIMP-1.

RESULTS

The TIMP-1/GAPDH mRNA expression level was significantly higher in invasive (stage II-IV) thymomas (means +/- SE, 81.4 +/- 28.1) than in noninvasive (stage I) thymomas (30.9 +/- 8.3, P = 0.026). The MMP-1/GAPDH mRNA expression level was also higher in invasive thymomas (19.7 +/- 7.5) than in non invasive thymomas (2.26 +/- 1.72, P = 0.020). Immunopositivity of TIMP-1 was localized in stromal cells adjacent to the advancing margin of the tumor.

CONCLUSIONS

These findings suggest that TIMPs and MMPs play an important role in the invasion of thymoma.

Endostatin gene therapy on murine lung metastases model utilizing cationic vector-mediated intravenous gene delivery

Tumors require ongoing angiogenesis to support their growth. Inhibition of angiogenesis by production of antiangiogenic factors should be a viable approach for cancer gene therapy. In this study, we investigated whether intravenous administration of endostatin gene complexed with a cationic vector (GL67/DOPE or PEI22K) could inhibit the development of lung tumors in mice injected i.v. with NFSa Y83 fibrosarcoma cells (5 x 10(5)) which frequently form lung metastasis. mRNA and protein of the transfected gene were produced in the lung and other organs of the transfected mice as assessed by immunohistochemistry, Western blotting and reverse transcription-polymerase chain reaction. Single intravenous injection of the endostatin gene (60 microg) complexed with either GL67/DOPE or PEI22K on day 3 or day 7 after fibrosarcoma cell inoculation significantly inhibited tumor formation in the lung as evidenced by the reduced number of lung tumors and lung weight, and prolonged survival of the endostatin gene-transfected mice compared with control mice. These findings suggested that the endostatin gene therapy, using cationic vector-mediated intravenous gene transfer, might be a feasible strategy for organ-targeted prevention and regulation of possible disseminated cancers.

[Therapeutic options which potentially cure patients with thymoma]

This study reports clinicopathologic features, treatment, and outcome of 107 thymomas, especially focusing on a combined modality program using hemithorax irradiation (HI) and restaging surgery using corticosteroid for advanced thymoma showing disseminative lesions. The use of HI after presumably total resection of the dissemination under posterolateral thoracotomy had no effect on reducing the incidence of relapsing. On the other hand, our own experience revealed that corticosteroid caused degenerative changes in the epithelial cells and lymphocytes of thymomas. The fact led us administer corticosteroid not only in preoperative setting but during postoperative HI. A better prognosis may be anticipated, although the follow up period is short and the number of patients involved is small.

Reduced effect of gemtuzumab ozogamicin (CMA-676) on P-glycoprotein and/or CD34-positive leukemia cells and its restoration by multidrug resistance modifiers

Gemtuzumab ozogamicin (CMA-676), a calicheamicin-conjugated humanized anti-CD33 mouse monoclonal antibody, has recently been introduced clinically as a promising drug for the treatment of patients with acute myeloid leukemia (AML), more than 90% of which express CD33 antigen. However, our recent study suggested that CMA-676 was excreted by a multi- drug-resistance (MDR) mechanism in P-glycoprotein (P-gp)-expressing leukemia cell lines. We analyzed the in vitro effects of CMA-676 on leukemia cells from 27 AML patients in relation to the amount of P-gp, MDR-associated protein 1 (MRP1), CD33 and CD34, using a multi-laser-equipped flow cytometer. The cytocidal effect of CMA-676, estimated by the amount of hypodiploid portion on cell cycle, was inversely related to the amount of P-gp estimated by MRK16 monoclonal antibody (P = 0.004), and to the P-gp function assessed by intracellular rhodamine-123 accumulation in the presence of PSC833 or MS209 as a MDR modifier (P = 0.0004 and P = 0.002, respectively). In addition, these MDR modifiers reversed CMA-676 resistance in P-gp-expressing CD33(+) leukemia cells (P = 0.001 with PSC833 and P = 0.0007 with MS209). In CD33(+) AML cells from 13 patients, CMA-676 was less effective on CD33(+)CD34(+) than CD33(+)CD34(-) cells (P = 0.002). PSC833 partially restored the effect of CMA-676 in CD33(+)CD34(+) cells. These results suggest that the combined use of CMA-676 and a MDR modifier will be more effective on CD33(+) AML with P-gp-related MDR.

Elevated serum vascular endothelial growth factor and basic fibroblast growth factor levels in patients with thymic epithelial neoplasms

Neovascularization, an essential event for the growth of solid tumors, is regulated by a number of angiogenic factors, among which vascular endothelial growth factor (VEGF) and basic fibroblast growth factor (bFGF), are considered to exert potent angiogenic activity. In this study, we investigated whether serum VEGF and bFGF levels could be predictors of the development and extension of thymic epithelial neoplasms. The subjects of this study were 37 patients with thymoma, 6 with thymic carcinoma, and 23 healthy volunteers. Serum samples were collected before clinical treatment. Serum VEGF levels were significantly (P < 0.05) elevated in the patients with thymic carcinoma (1,080 +/- 1,185pg/ml) compared with those in the healthy volunteers (407 +/- 589 microg/ml). Serum bFGF levels were also significantly (P < 0.05) elevated in the patients with thymic carcinoma (2740 +/- 631 pg/ml) compared with those in the healthy volunteers (1728 +/- 1,192 pg/ml). However, the serum VEGF and bFGF levels did not significantly differ between the patients with thymoma and the healthy volunteers. Serum VEGF and bFGF levels did not significantly differ according to the stage and pathological subtype of thymoma. Moreover, there was no correlation between the serum levels of VEGF and those of bFGF. Thus, while serum VEGF and bFGF levels may serve as markers for thymic epithelial tumors, it is unlikely that circulating VEGF and bFGF could be used as markers for assessing the progression of thymoma tumors.

Expression of the prothymosin-a gene as a prognostic factor in lung cancer

Prothymosin-alpha (PTalpha) is known to play a role in cell proliferation, and the PTalpha mRNA level may reflect the degree of proliferation of tumor cells. It has been reported that PTalpha mRNA levels are higher in human colon and liver cancer tissues than in the adjacent normal tissues. We examined the mRNA levels of PTalpha and c-myc in 20 lung cancers, using Bas 2500Mac systems. The PTalpha and c-myc mRNA levels in lung cancer tissues were higher than those in normal lung tissues; however, the PTalpha mRNA levels did not correlate with the stage or pathological subtype of the lung cancer and there was no correlation between the expression of PTalpha and c-myc. PTalpha mRNA overexpression in lung cancer was correlated with a poor prognosis.

Autoantibody to gravin is expressed more strongly in younger and nonthymomatous patients with myasthenia gravis

Gravin is expressed in several cell and tissue types as either 300 kDa doublet or 250 kDa proteolytic products. It is a cytoplasmic antigen that reacts with the serum of patients with myasthenia gravis (MG). Autoantibodies to gravin residues 1477-1781 are highly specific for MG. In the present study, we examined residues 1477-1781 in detail and found that residues 1542-1547 of gravin protein, which had sequence homology with the binding sequences of two protein A-kinase anchoring proteins, were highly reactive to MG serum. Antigravin antibody activities were stronger in younger and nonthymomatous patients. These findings suggest that antigravin antibody activities could be a useful prognostic factor and that the gravin antibody of MG may have a function which prevents the protein A-kinase binding pathway.

[Surgery for multiple primary lung cancers]

Thirty-eight patients (3.4%) of multiple primary lung cancers were treated among 1,106 patients of lung cancer at Nagoya City University Hospital. Twenty-eight patients had multiple lung lesions at the same time. Ten had the second primary lung cancer from 5 to 12 years after the first operation. Thirty-six patients had the second operation, and two had adjuvant therapy for lung cancer. Their 5 year survival rate was 36%. Especially of the patients with stage I lung cancer, 5 year survival rate was 65%. Radical but less invasive operation like VATS should be chosen for their treatment.

Expression of the MTA1 mRNA in thymoma patients

The MTA1 gene is a recently identified metastasis-associated gene which has been implicated in the signal transduction or regulation of gene expression. We examined the mRNA expression levels of the MTA1, the human homologue of the rat mta1 gene in thymoma. Expression of MTA1 mRNA was evaluated by reverse transcription polymerase chain reaction (RT-PCR) in 30 thymoma samples using LightCycler. The data was analyzed in reference to clinicopathological data. There was no relationship between MTA1 gene expression and age and gender. MTA1/GAPDH mRNA level in stage IV thymoma (6.431+/-3.404) was significantly higher than the level in stage I thymoma (2.592+/-1.902, P=0.0081). There was a tendency towards higher MTA1/GAPDH mRNA level in stage IV thymoma when compared to stage II thymoma (3.746+/-3.292, P=0.072). Thus our results show that the expression of the MTA1 gene is closely related to invasiveness in thymoma. The gene MTA1 could potentially provide information on the mechanism of tumor invasion and metastasis.

Role of P-glycoprotein in all-trans retinoic acid (ATRA) resistance in acute promyelocytic leukaemia cells: analysis of intracellular concentration of ATRA

We analysed the relationship between all-trans retinoic acid (ATRA) resistance and P-glycoprotein (P-gp)-associated multidrug resistance (MDR) in acute promyelocytic leukaemia (APL). There was no difference in the intracellular ATRA accumulation between NB4 cells and an MDR1 cDNA-transduced NB4 subline and between ATRA-resistant NB4 cells (NB4/RA) and an MDR1 cDNA-transduced NB4/RA subline. PSC833, a MDR modifier, did not increase the intracellular accumulation of ATRA or affect the expression of CD11b, the nitroblue tetrazolium (NBT) reduction activity, the proportion of apoptotic cells or the morphology of these four ATRA-treated cell lines. Similar results were obtained in the analysis of APL cells from five patients relapsed after ATRA-induced complete remission.

Expression of the sensitive to apoptosis gene, SAG, as a prognostic marker in nonsmall cell lung cancer

Inhibition of programmed cell death (apoptosis) is associated with increased tumor aggressiveness. We hypothesized that a novel sensitive to apoptosis gene, SAG, may be expressed in tumors of patients with nonsmall cell lung cancer (NSCLC) and may affect their clinical outcome. Expression of SAG messenger RNA was evaluated by reverse transcription polymerase chain reaction in 80 nonsmall cell lung carcinomas and 65 adjacent histologic nonmalignant lung samples using a LightCycler. The data were analyzed in reference to clinicopathologic data and survival. The SAG/GAPDH mRNA level in 80 NSCLC was 2.337 +/- 1.972. Of 65 paired NSCLC and nonmalignant lung samples, SAG/GAPDH mRNA levels were 2.313 +/- 2.064 and 1.696 +/- 1.910, respectively. The SAG mRNA level was significantly higher in NSCLC compared with nonmalignant lung tissue (p = 0.0169). There was no relationship between SAG gene expression and age, gender, T- or N-status or clinical stages. The NSCLC patients with high SAG/GAPDH expression (>1.8) had significantly poorer survival than the patients with low SAG/GAPDH expression (<1.8, p = 0.0227). Thus we suggest that SAG gene expression in NSCLC may be a useful prognostic marker.

Continuous lumbar drainage for the preoperative management of patients with aneurysmal subarachnoid hemorrhage

Continuous drainage of lumbar cerebrospinal fluid (CSF) was analyzed for the preoperative management of patients with aneurysmal subarachnoid hemorrhage (SAH) in 50 consecutive cases of surgically treated aneurysmal SAH. Patients were divided into a lumbar drainage group, in whom continuous lumbar CSF drainage was established for preoperative management, and a non-lumbar drainage group. Rebleeding from the aneurysm during the insertion of the lumbar drainage tube and during continuous lumbar drainage, effect on the control of the systolic blood pressure, and effect on the sedation of the patient were examined. Continuous lumbar CSF drainage significantly decreased the systolic blood pressure. Seven of 17 patients in the non-lumbar drainage group had systolic blood pressure uncontrollable to below 150 mmHg even when a large amount of nicardipine was used, whereas only two of 33 patients had the same problem in the lumbar drainage group. Sedation was better in the patients in the lumbar drainage group with a smaller amount of analgesics. The rebleeding rate was 11.7% among patients in the non-lumbar drainage group, and 9.09% among patients in the lumbar drainage group. No rebleeding occurred during insertion of the lumbar drainage catheter. Continuous lumbar CSF drainage improved control of systolic pressure and sedation, and is a useful method of preoperative management for patients with aneurysmal SAH.

Clinical significance of matrix metalloproteinase-7 and Ets-1 gene expression in patients with lung cancer

BACKGROUND

Matrix metalloproteinase-7 (MMP-7) is a member of the MMP family and has a wide variety of substrate spectra. Ets domain transcription factors are reported to play an important role in carcinoma invasion and metastasis. The regulatory role of Ets-1 has been shown in several MMPs. We have hypothesized that MMP-7 and Ets-1 mRNA levels could be predictors of the development and invasion of lung cancer.

METHODS

The study included 73 lung cancer cases. The mRNA levels were quantified by real-time reverse transcription-polymerase chain reaction (RT-PCR) using a LightCycler.

RESULTS

No significant difference in MMP-7 and Ets-1 mRNA levels was found among gender, age, and pathological subtype. The MMP-7 mRNA levels were elevated in tumor tissues from stage II-IV lung cancer (1.629 +/- 2.267) compared to those from stage I lung cancer (0.762 +/- 1.463) (P = 0.0290). There was a tendency toward higher MMP-7 mRNA expression levels in tumors with lymph node metastasis (1.728 +/- 2.432) compared to those without lymph node metastasis (1.141 +/- 1.838) (P = 0.1076). Thus, MMP-7 mRNA levels may serve as a marker of higher stages in lung cancer. No significant difference in Ets-1 mRNA levels was found among clinical stages and T-status. The Ets-1 mRNA levels were elevated in tumors from N2 patients (7.512 +/- 13.306) compared to those from N0 patients (2.525 +/- 4.719) (P = 0.0209). Ets-1 mRNA levels showed a positive correlation with MMP-7 expression (P = 0.0042).

CONCLUSIONS

Using the LightCycler RT-PCR assay, the determination of MMP-7 and Ets-1 mRNA levels might provide a potential marker for advanced lung cancer. However, further studies and a longer follow-up are needed to confirm the impact of MMP-7 in the biological behavior of the tumor.

Expression of the cdc25B gene as a prognosis marker in non-small cell lung cancer

There is an evidence to suggest that cdc25B phosphatase is an oncogenic. We hypothesized that cdc25B gene may be expressed in tumors of patients with non-small cell lung cancer (NSCLC) and affect their clinical outcome. Expression of cdc25B messenger RNA was evaluated by reverse transcription polymerase chain reaction in 55 non-small cell lung carcinomas and adjacent histological normal lung samples using LightCycler. The data was analyzed in reference to clinicopathological data and survival data. There was no difference of cdc25B expression level between the NSCLC tissue and normal lung tissue. There was no relationship between cdc25B gene expression and age, gender, N or T-status and clinical stage. However, the NSCLC patients with high cdc25B expression had significantly poor survival than the patients with low cdc25B expression (P=0.0173). Thus we suggest that cdc25B may predict poor survival.

Expression of the sensitive to apoptosis gene, SAG, as a prognostic marker in nonsmall cell lung cancer

Inhibition of programmed cell death (apoptosis) is associated with increased tumor aggressiveness. We hypothesized that a novel sensitive to apoptosis gene, SAG, may be expressed in tumors of patients with nonsmall cell lung cancer (NSCLC) and may affect their clinical outcome. Expression of SAG messenger RNA was evaluated by reverse transcription polymerase chain reaction in 80 nonsmall cell lung carcinomas and 65 adjacent histologic nonmalignant lung samples using a LightCycler. The data were analyzed in reference to clinicopathologic data and survival. The SAG/GAPDH mRNA level in 80 NSCLC was 2.337 +/- 1.972. Of 65 paired NSCLC and nonmalignant lung samples, SAG/GAPDH mRNA levels were 2.313 +/- 2.064 and 1.696 +/- 1.910, respectively. The SAG mRNA level was significantly higher in NSCLC compared with nonmalignant lung tissue (p = 0.0169). There was no relationship between SAG gene expression and age, gender, T- or N-status or clinical stages. The NSCLC patients with high SAG/GAPDH expression (>1.8) had significantly poorer survival than the patients with low SAG/GAPDH expression (<1.8, p = 0.0227). Thus we suggest that SAG gene expression in NSCLC may be a useful prognostic marker.

Expression of the protein gene product 9.5, PGP9.5, is correlated with T-status in non-small cell lung cancer

BACKGROUND

In a tumor, increased deubiquitination of cyclins by a protein gene product gene, PGP9.5, could contribute to the uncontrolled growth of somatic cells that is a hallmark of cancer. We hypothesized that PGP9.5 may be expressed in tumors of patients with non-small cell lung cancer (NSCLC).

METHODS

Expression of PGP9.5 messenger RNA was evaluated by reverse transcription polymerase chain reaction (RT-PCR) in 95 non-small cell lung carcinomas and adjacent histological normal lung samples. The data were analyzed with reference to clinicopathological factors.

RESULTS

PGP9.5 transcripts were detected in 18 (12.8%) of the tumor samples, although some of paired normal lung samples showed very weak expression. There was no relationship between PGP9.5 gene expression and age, gender, N-status or pathological subtype. PGP9.5 gene was preferentially expressed in T3/T4 NSCLC (12/41, 29.3%) compared with T1/T2 NSCLC (6/54, 11.1%) (p = 0.0482).

CONCLUSIONS

Although the PGP9.5 gene was not expressed in a majority of NSCLC tumors, we suggest that PGP9.5 may correlate with tumor invasion or progression of NSCLC.