A multi-centre, retrospective case series of oocyte cryopreservation in unmarried women diagnosed with haematological malignancies

STUDY QUESTION

Is oocyte cryopreservation an applicable option for fertility preservation in unmarried patients with haematological malignancies?

SUMMARY ANSWER

Oocyte cryopreservation via the vitrification method is accessible and may be considered an option for fertility preservation in unmarried patients with haematological malignancies.

WHAT IS KNOWN ALREADY

Haematological malignancies are most commonly observed amongst adolescent and young adult women. Although the survival rate and life expectancy of those with haematological malignancies have improved, chemotherapy and radiotherapy may impair their reproductive potential. Oocyte cryopreservation is thus an ideal option to preserve their fertility.

STUDY DESIGN SIZE DURATION

This study retrospectively evaluated 193 unmarried patients (age: 26.2 ± 0.4 years) with haematological malignancies, who consulted for oocyte cryopreservation across 20 different fertility centres in Japan between February 2007 and January 2015. The primary outcome measures were the oocyte retrievals and oocyte cryopreservation outcomes. The secondary outcome measures were the outcomes following oocyte warming for IVF.

PARTICIPANTS/MATERIALS SETTING METHODS

The patients had commenced ovarian stimulation cycles via antagonist, agonist, natural and minimal methods for oocyte retrievals, defined according to the treatment strategy of each respective fertility centre. A vitrification method using the Cryotop safety kit was used for oocyte cryopreservation. ICSIs were used for insemination of warmed oocytes. The endometrial preparation method for embryo transfer was hormonal replacement therapy, except in the case of a patient who underwent a spontaneous ovulatory cycle.

MAIN RESULTS AND THE ROLE OF CHANCE

Among 193 patients, acute myeloid leukaemia (n = 45, 23.3%) was most common, followed by acute lymphoid leukaemia (n = 38, 19.7%) and Hodgkin's lymphoma (n = 30, 15.5%). In total, 162 patients (83.9%) underwent oocyte retrieval, and oocytes were successfully cryopreserved for 155 patients (80.3%). The mean number of oocyte retrieval cycles and cryopreserved oocytes were 1.7 ± 0.2 and 6.3 ± 0.4, respectively. As of December 2019, 14 patients (9.2%) had requested oocyte warming for IVF. The survival rate of oocytes after vitrification-warming was 85.2% (75/88). The rates of fertilisation and embryo development were 80.0% (60/75) and 46.7% (28/60), respectively. Ten patients (71.4%) had successful embryo transfers, and seven live births (50.0%) were achieved.

LIMITATIONS REASONS FOR CAUTION

This study was limited by its retrospective nature. Additionally, there remains an insufficient number of cases regarding the warming of vitrified oocytes to reliably conclude whether oocyte cryopreservation is effective for patients with haematological malignancies. Further long-term follow-up study is required.

WIDER IMPLICATIONS OF THE FINDINGS

Oocyte retrieval and oocyte cryopreservation were accessible for patients with haematological malignancies; however, the number of oocyte retrievals may have been limited due to the initiation of cancer treatments. Acceptable embryonic and pregnancy outcomes could be achieved following oocyte warming; therefore, our results suggest that oocyte cryopreservation can be considered an option for fertility preservation in patients with haematological malignancies.

STUDY FUNDING/COMPETING INTERESTS

This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors. The authors declare no conflict of interest.

TRIAL REGISTRATION NUMBER

N/A.

Stent-Graft Treatment of Dissecting Aneurysm in Association with Aortic Intramural Hematoma: When Should the Procedure Be Performed?

Purpose:

To report 2 cases of stent-graft implantation for localized dissecting aneurysm during the conservative treatment of aortic intramural hematoma.

Case Reports:

One patient underwent stent-graft implantation for 2 localized dissecting aneurysms about 23 months after symptom onset. Computed tomography (CT) 1 year after the procedure demonstrated aneurysm shrinkage. In the other patient, a localized dissecting aneurysm was treated about 3 months after symptom onset, even though the intramural hematoma had not resolved. CT scanning 3 months after the procedure demonstrated aneurysm shrinkage, but also revealed poor attachment of the distal stent-graft to the aortic wall due to subsequent resolution of the hematoma.

Conclusions:

Endograft implantation for treatment of localized dissecting aneurysm associated with aortic intramural hematoma should probably not be performed before the hematoma has completely resolved.

A potent anti-angiogenic factor, vasohibin-1, ameliorates experimental bronchiolitis obliterans

BACKGROUND

Bronchiolitis obliterans (BO) is a major cause of morbidity and mortality after lung transplantation. BO is pathologically characterized by neovascularized fibro-obliteration of the allograft airway. A recent study has shown that aberrant angiogenesis during fibro-obliteration contributes to the pathogenesis of BO. Vasohibin-1 (VASH1) has been isolated as a vascular endothelial growth factor-inducible gene in endothelial cells (ECs) that inhibits migration and proliferation of ECs and exhibits anti-angiogenic activity in vivo.

PURPOSE

This study examines whether VASH1 inhibits fibro-obliteration of the allograft in a murine intrapulmonary tracheal transplantation model.

METHOD

Tracheal allografts of BALB/c mouse were transplanted into the left lung of recipient C57BL/6J mouse. We performed gene transfer to the recipient lungs using an adenovirus vector encoding human VASH1 (Ad-VASH1) or beta- garactosidase (Ad-LacZ) as the control. Tracheal allografts were harvested and pathological on days 21 and 28.

RESULT

Ad-VASH1 treatment reduced the vascular area on day 21 (4.6% versus 13.0%, P = .037) and day 28 (5.4% versus 13.4%, P = .022) compared with the control group. This was accompanied by significantly inhibited luminal obliteration of the tracheal allografts in the animals transferred with Ad-VASH1 compared with the control (69% versus 93%, P = .028) on day 21. We were not able to observe this effect on day 28 (92% versus 97%, P = .48).

CONCLUSION

Transgene expression of VASH1 in the recipient lung significantly attenuated luminal obliteration of the tracheal allograft; this was associated with significantly reduced aberrant angiogenesis in the fibro-obliterative tissue in a murine model intrapulmonary tracheal transplantation.

Arthroscopic partial limbectomy for labral injury of the hip: a case with a 16-year follow-up

Although good to excellent short-term results of arthroscopic partial limbectomy of the hip have been reported, there is little information on the long-term outcome of the procedure. We report a case with a 16-year follow-up. A 34-year old woman presented with a three-month history of severe pain and limitation of movement of the hip. Plain radiographs and arthrography showed no abnormality. MRI showed an effusion and a deformity of the anterosuperior part of the labrum. This was confirmed as an inverted labral tear that was debrided arthroscopically. At 16 years post-operatively, she remained symptom-free. Plain radiographs showed no abnormality and MRI suggested that the sealing effect of the scar tissue prevented articular damage and degeneration.

Two-week cast immobilization induced chronic widespread hyperalgesia in rats

It has been postulated that physical immobilization is an essential factor in developing chronic pain after trauma or surgery in an extremity. However, the mechanisms of sustained immobilization-induced chronic pain remain poorly understood. The present study, therefore, aimed to develop a rat model for chronic post-cast pain (CPCP) and to clarify the mechanism(s) underlying CPCP. To investigate the effects of cast immobilization on pain behaviours in rats, one hindlimb was immobilized for 2 weeks with a cast and remobilization was conducted for 10 weeks. Cast immobilization induced muscle atrophy and inflammatory changes in the immobilized hindlimb that began 2 h after cast removal and continued for 1 week. Spontaneous pain-related behaviours (licking and reduction in weight bearing) in the immobilized hindlimb were observed for 2 weeks, and widespread mechanical hyperalgesia in bilateral calves, hindpaws and tail all continued for 5-10 weeks after cast removal. A sciatic nerve block with lidocaine 24 h after cast removal transitorily abolished bilateral mechanical hyperalgesia in CPCP rats, suggesting that sensory inputs originating in the immobilized hindlimb contribute to the mechanism of both ipsilateral and contralateral hyperalgesia. Intraperitoneal injection of the free radical scavengers 4-hydroxy-2,2,6,6-tetramethylpiperydine-1-oxy1 or N-acetylcysteine 24 h after cast removal clearly inhibited mechanical hyperalgesia in bilateral calves and hindpaws in CPCP rats. These results suggest that cast immobilization induces ischaemia/reperfusion injury in the hindlimb and consequent production of oxygen free radicals, which may be involved in the mechanism of widespread hyperalgesia in CPCP rats.

Heat-induced growth inhibition and apoptosis in transplanted human head and neck squamous cell carcinomas with different status of p53

To examine p53-dependency in hyperthermic cancer therapy, heat-induced growth inhibition and apoptosis in transplanted human head and neck squamous cell carcinoma (HNSCC) tumours were analysed with different status of p53 into nude mice. The tumour tissue from HNSCC cell line (SAS) transfected with mutant p53 gene (SAS/mp53) or control vector containing neo gene (SAS/neo) was transplanted into the subcutaneous tissue of the thigh of nude mice using a trocar. Hyperthermia was performed at 42 degrees C when the mean diameter of tumour was 5-6mm. The diameter of tumours was measured using vernier calipers and tumour weight (TW) and the relative tumour weight (RW) was calculated. Tumour regrowth delay was evaluated when the RW reached 5-fold against the control group. The accumulation of p53 and Bax proteins was examined by an immunohistochemical technique. Apoptotic cells in the sections were detected by staining of DNA ends using an immunohistochemical technique. SAS/mp53 tumours showed more heat-resistance than SAS/neo tumours. The p53-positively staining cells were observed in untreated SAS/mp53 tumours, but not in untreated SAS/neo tumours. After heat treatment, the accumulation of p53 and Bax proteins was observed in SAS/neo tumours, but little in SAS/mp53 tumours. The incidence of apoptotic cells induced by heat treatment was very low in SAS/mp53 tumours compared with SAS/neo tumours. In conclusion, the heat-induced growth inhibition of a transplanted HNSCC may be correlated with the induction of p53-dependent Bax-mediated apoptosis. Thus, p53 status appears to be one of the useful parameters for the predictive assays in hyperthermic cancer therapy.

[Role of PGI2 in ectopic bone formation of spinal ligaments]

Ossification of the posterior longitudinal ligament (OPLL) is characterized by ectopic bone formation in the spinal ligaments. It has been suggested some role of mechanical stress in the progression of OPLL. Differential display RT-PCR was carried out to identify the genes participating in OPLL. A cDNA fragment corresponding to PGI2 synthase was highly expressed in OPLL cells compared to non-OPLL cells. To examine the effect of mechanical stress on the PGI2 synthase expression, cells were subjected to cyclic stretch and PGI2 synthase expression was assessed by quantitative RT-PCR. Cyclic stretch induced a time-dependent increase in PGI2 synthase in OPLL cells but not in non-OPLL cells. The increase in PGI2 synthase was diminished by SQ22536, a potent adenylate cyclase inhibitor. Cyclic stretch also induced PGI2 production. Beraprost and dibutyryl cAMP increased the mRNA expression of alkaline phosphatase (ALP) as a marker for osteogenic differentiation in OPLL cells, whereas no change was observed in non-OPLL cells. Beraprost- and stretch-induced increases in ALP expressions were inhibited by SQ22536. These data suggest that PGI2 synthase activated by mechanical stress plays a key role in the progression of OPLL, at least in part through the osteogenic differentiation in spinal ligament cells via the PGI2/cAMP system.

Extranodal lymphoblastic lymphoma of suspected B-cell lineage in the gingiva of a racehorse, accompanied by mandibular osteolysis

A mass developed in the mandibular gingiva of a thoroughbred racehorse. When the horse could no longer eat unassisted, it was killed and immediately autopsied. Macroscopically, the mandible exhibited extensive osteolysis, with only a small amount of bone remaining around the tooth roots. The cut surface of the mass around the mandible consisted of neoplastic medullary tissue, in which osteogenesis was observed. The medullary tissue was composed of pleomorphic medium-sized to large cells, interlaced by collagen bundles. These cells had large, pale, round or ovoid, sometimes cleaved nuclei, with one or two prominent nucleoli. Mitoses were numerous. Electron microscopy showed that the cells in the medullary tissues were similar in shape to undifferentiated lymphocytes. Immunohistochemically, these cells were positive for B-cell associated antigen in the pre-B-cell stage. Our findings suggest that the horse had extranodal lymphoblastic lymphoma of suspected B-cell lineage, possibly originating from the lymphatic system of the gingiva. We consider that the osteolysis resulted from activation of osteoclasts by proliferation of the tumour cells.

[Progress in liver surgery]

In the 1980s, new methods such as intra-operative ultrasonography, hemihepatic vascular occlusion and ultrasonically guided subsegmentectomy were introduced in clinical practice for use in hepatic surgery. Because of the progress, surgical resection of hepatocellular carcinomas associated with cirrhosis became safer, and curativity and hepatic functional preservation were promoted. The long-term survival rate after operation has improved. Recently, the use of the procedures of vascular surgery transplant surgery has allowed the indication for hepatectomy to be expanded. Here we describe the transition and progress in hepatic surgery.

Brainstem auditory regions in mice: expression of nociceptin/orphanin FQ precursor mRNA in select neurons

Nociceptin peptide-receptor system is known to be essential for the regulation of hearing ability. The mRNA for nociceptin precursor protein is highly expressed in the brainstem. We explored a detailed hybridohistochemical expression pattern of the nociceptin precursor mRNA in the mouse brainstem, and identified positive cells in several auditory brainstem nuclei. Positive cells were seen in the dorsal and ventral nuclei of the lateral lemniscus, the rostral periolivary region, the lateroventral and medioventral periolivary nuclei, the dorsal periolivary region, the superior paraolivary nucleus, and the external cortex and dorsal cortex of the inferior colliculus. Of these, the medioventral and lateroventral periolivary nuclei, the major sites of origin of olivocochlear bundle, were most populated by positive cells.

Conformational comparison of mu-selective endomorphin-2 with its C-terminal free acid in DMSO solution, by 1H NMR spectroscopy and molecular modeling calculation

In order to make clear the structural role of the C-terminal amide group of endomorphin-2 (EM2, H-Tyr-Pro-Phe-Phe-NH2), an endogenous mu-receptor ligand, in the biological function, the solution conformations of endomorphin-2 and its C-terminal free acid (EM2OH, H-Tyr-Pro-Phe-Phe-OH), studied using two-dimensional 1H NMR measurements and molecular modeling calculations, were compared. Both peptides were in equilibrium between the cis and trans isomers around the Tyr-Pro omega bond in a population ratio of approximately/= 1:2. The lack of significant temperature and concentration dependence of NH protons suggested that the NMR spectra reflected the conformational features of the respective molecules themselves. Fifty possible 3D structures for the each isomer were generated by the dynamical simulated annealing method under the proton-proton distance constraints derived from the ROE cross-peaks. These energy-minimized conformers, which were all in the phi torsion angles estimated from J(NHCalphaH) coupling constants within +/- 30 degrees, were then classified in groups one or two according to the folding backbone structures. All trans and cis EM2 conformers adopt an open conformation in which their extended backbone structures are twisted at the Pro2-Phe3 moiety. In contrast, the trans and cis conformers of EM2OH show conformational variation between the 'bow'-shaped extended and folded backbone structures, although the cis conformers of its zwitterionic form are refined into the folded structure of the close disposition of C- and N-terminal groups. These results indicate clearly that the substitution of carboxyl group for C-terminal amide group makes the peptide flexible. The conformational requirement for mu-receptor activation has been discussed based on the active form proposed for endomorphin-1 and by comparing conformational features of EM2 and EM2OH.

Detection of early venous filling in gliomas on MRI: preliminary study by 2D time-resolved dynamic contrast-enhanced MR angiography with echo-sharing technique

We evaluated the detection of early venous filling of gliomas by 2D time resolved dynamic contrast enhanced MR digital subtraction angiography (MR-DSA) with echo-sharing technique and compared the results with those of conventional contrast digital subtraction angiography (C-DSA). C-DSA and MR-DSA examinations were performed in eight patients with malignant gliomas and compared with regard to the visualization of early filling veins; time intensity curves of arteries, early filling veins and normal veins were made, and rise time and time to peak were evaluated. MR-DSA visualized 12 out of 17 early filling veins depicted on C-DSA. The failure of five veins to be depicted may be due to the overlapping of other structures, such as other vessels and tumor stain. On time intensity curves, the mean difference in rise time was 0.9 sec between the artery and early filling vein, and the mean difference of time to peak was 1.6 sec. C-DSA has been the modality of choice in demonstrating early venous filling, a useful finding in the differential diagnosis of gliomas. However the high temporal resolution of MR-DSA with echo-sharing technique provides sufficient visualization of early venous filling of gliomas. Additional information for precise differential diagnosis may be obtained by adding MR-DSA to the imaging protocol for gliomas.

Impact of LKM512 yogurt on improvement of intestinal environment of the elderly

Improvement of the intestinal environment by administration of LKM512 yogurt was examined using polyamine, haptoglobin and mutagenicity as indexes which directly reflect the health condition of the host. The concentration of spermine in feces increased significantly by 3-fold (P<0.05) at week 2 of administration of LKM512 yogurt compared with before administration, and that of putrescine, spermidine, and cadaverine also tended to increase with administration of LKM512 yogurt. The haptoglobin content in feces decreased significantly (P<0.05) at week 2 of administration of LKM512 yogurt, and it showed a negative correlation with the polyamine content, indicating that acute intestinal inflammation was suppressed. Fecal mutagenicity was measured using fecal extract and fecal precipitate. Both preparations showed similar significant decreases (P<0.05) by the administration of LKM512 yogurt, as well as a negative correlation with polyamine content. This result indicated that antimutagenicity due to administration of LKM512 yogurt was not based on binding of the mutagen to the bacterial cell wall. Many reports have suggested that polyamines increased by the administration of LKM512 yogurt led to inhibition of inflammation and antimutagenicity in the intestinal tract.

Stereospecific 1,3-migration of an Fe(CO)3 group on acyclic conjugated polyenes: application to remote and iterative asymmetric induction

The stereochemical outcome of the 1,3- and 1,5-migration of an Fe(CO)3 group on (acyclic polyene)Fe(CO)3 complexes and their application to stereoselective construction of remote and contiguous stereogenic centers are described. Treatment of the [(eta(4)-4-7)triene]Fe(CO)3 complexes 1a-d bearing an electron-withdrawing group on the terminal position of an uncomplexed olefin with a base such as KN(SiMe3)2 (KHMDS) and LiCH2CN induced the 1,3-migration reaction of the Fe(CO)3 group, giving the [(eta4-2-5)triene]Fe(CO)3 complexes 2a-d in moderate to good yields, depending on the electron-withdrawing groups. From an experiment using the chiral (trienenitril)Fe(CO)3 complex 5, it is revealed that the 1,3-migration proceeds with inversion of configuration. Similarly, the 1,5-migration reaction of the[(eta4-6-9)tetraenone]Fe(CO)3 complexes 9 occurred with a catalytic amount of KHMDS, giving the [(eta4-2-5)tetraenone]Fe(CO)3 complexes 10 with retention of configuration. Furthermore, we have succeeded in the first regio- and stereoselective nucleophilic substitution of the (3,5-diene-1,2-diol) Fe(CO)3 complexes (15 --> 24a-h) with various nucleophiles via the ortho esters 21. By using iterative manipulation of the above two reactions, remote stereocontrol of the terminal substituents on acyclic polyene (9 --> 12) and construction of contiguous stereogenic centers (19, 28) have been achieved.

[Usefulness of three-dimensional color Doppler sonography for the differential diagnosis of subpleural lesions]

The purpose of our investigation was to assess the usefulness of three-dimensional color Doppler sonography (velocity mode and power mode) for the differential diagnosis of subpleural lesions. Thirty lesions (11 pneumonias, 5 lung abscesses, 11 primary lung cancers, 3 metastatic lung cancers) were examined. Three-dimensional images were reconstructed by a maximum intensity projection method. Three-dimensional representations of intralesional blood flow became available for all lesions approximately 11 seconds after scanning. In every case, the entire vasculature of the tumor, the pneumonia, the abscess, or the inflamed region of the lung was appreciated more easily from three-dimensional images than from two-dimensional images. We classified the color flow pattern of subpleural lesions depicted by color flow imaging into seven groups. Color flow was depicted better by the three-dimensional color Doppler power mode than the velocity mode. Three-dimensional color flow patterns observed in power mode, patterns of the pneumonias and the lung cancers differed significantly. Our results suggest that the three-dimensional color Doppler power mode is useful for the differential diagnosis of subpleural lesions.

Asymmetric total synthesis of halicholactone

The asymmetric total synthesis of the marine metabolite, halicholactone 1, is described. The bisallylic triol 6 with three chiral centers at C8, C12, and C15 was constructed by [2,3]-sigmatropic rearrangement of the sulfoxide 18, which was prepared stereoselectively using the chirality of (diene)Fe(CO)3 complexes. Introduction of the trans-substituted cyclopropane subunit into 21 was successfully achieved using the modified regio- and stereoselective Simmons-Smith reaction. The use of RCM (ring-closing metathesis) methodology (4-->35) was pivotal for the formation of a nine-membered unsaturated lactone fragment of halicholactone 1. As this approach is flexible and stereoselective, other oxylipins could be synthesized by the protocol described herein.

Nondiffuse fatty change of the liver: discerning pseudotumor on MR images enhanced with ferumoxides-initial observations

PURPOSE

To clarify the findings of nondiffuse fatty change of the liver on ferumoxides-enhanced magnetic resonance (MR) images.

MATERIALS AND METHODS

Of 202 patients who underwent ferumoxides-enhanced MR imaging, eight who had nondiffuse fatty change of the liver at computed tomography (CT) were examined as study subjects. MR imaging findings before and 1 hour after ferumoxides administration were compared with CT findings.

RESULTS

Focal fatty areas of the liver showing low attenuation on CT images were depicted as areas of relatively high intensity on the ferumoxides-enhanced T1-weighted images in all patients. On enhanced T2-weighted images, focal fatty change showed relatively high intensity in three and isointensity in one of the four patients. Focal spared areas appearing as areas of relatively high attenuation on CT images were depicted as areas of relatively low intensity on the ferumoxides-enhanced T1- and T2-weighted images in all patients.

CONCLUSION

Although prior reports of hepatic MR imaging with ferumoxides indicated that there is accumulation of ferumoxides within focal fatty areas that are no longer seen after the administration of contrast medium, this study revealed that focal fatty change and focal spared areas of fatty liver may be pseudotumors because of the relatively high intensity of fatty areas of the liver. Radiologists can distinguish these conditions from hepatic tumors by using the opposed-phase gradient-echo sequence or the fat-saturation technique.

Gallyas-positive argyrophilic and ubiquitinated filamentous inclusions in rapidly progressive motor neuron disease: immunohistochemical and electron microscopic studies

In an autopsy case of sporadic rapidly progressive lower motor neuron disease (MND), Gallyas-positive argyrophilic and ubiquitinated filamentous intracytoplasmic inclusions were found in the neurons. Clinically, 7 months prior to death, a 68-year-old woman experienced a history of rapidly progressive muscle weakness of all four extremities and bulbar sign, without sensory and autonomic disturbance. Two months later, she became unable to stand or walk. Four months after onset, she needed respiratory support, and subsequently died due to cardiorespiratory arrest. Neuropathological examinations revealed neuronal loss and associated gliosis in the lower motor neurons, except for ocular motor nuclei, Clark's column, and accessory cuneate nucleus, and tract degeneration was observed in the middle root zone of the posterior column and spinocerebellar tract. No Bunina bodies or Lewy body-like hyaline inclusions were found in the anterior horns. Gallyaspositive argyrophilic filamentous inclusions were found in the lower motor neurons and in nerve cells of the Clark's column, intermediate zone, posterior horn and accessory cuneate nucleus. These were positive with anti-ubiquitin antibody but negative with anti-tau (tau-2 and AT8) and neurofilament antibodies. Electron microscopic examinations disclosed randomly arranged tubular-like filamentous profiles, with a diameter of 12-14 nm, sometimes with amorphous granules in the perikaryon. This is the first report on the Gallyas-positive argyrophilic and ubiquitinated filamentous inclusions in neurons in MND.

Clinical evaluation of 99mTc-Technegas SPECT in thoracoscopic lung volume reduction surgery in patients with pulmonary emphysema

99mTc-Technegas (Tcgas) SPECT is useful for evaluating the patency of the airway and highly sensitive in detecting regional pulmonary function in pulmonary emphysema. The aim of this study is to evaluate regional ventilation impairment by this method pre and post thoracoscopic lung volume reduction surgery (LVRS) in patients with pulmonary emphysema.

METHODS

There were 11 patients with pulmonary emphysema. The mean age of patients was 64.1 years. All patients were males. LVRS was performed bilaterally in 8 patients and unilaterally in 3 patients. Post inhalation of Tcgas in the sitting position, the subjects were placed in the supine position and SPECT was performed. Distribution of Tcgas on axial images was classified into 4 types, A: homogeneous, B: inhomogeneous, C: hot spot, D: defect. Three slices of axial SPECT images, the upper, middle and lower fields were selected, and changes in deposition patterns post LVRS were scored (Tcgas score).

RESULTS

Post LVRS, dyspnea on exertion and pulmonary function tests were improved. Pre LVRS, inhomogeneous distribution, hot spots and defects were observed in all patients. Post LVRS, improvement in distribution was obtained not only in the surgical field and other fields, but also in the contralateral lung of unilaterally operated patients. In 5 patients some fields showed deterioration. The Tcgas score correlated with improvements in FEV1.0, FEV1.0% and %FEV1.0.

CONCLUSION

Tcgas SPECT is useful for evaluating changes in regional pulmonary function post LVRS.

[Experimental study of esophageal covered stent for prevention of migration: use of clay to simulate stenosis of the esophagogastric junction or anastomosis site]

PURPOSE

An inner-covered Spiral Z-stent (IC-SZ) developed by our group was examined for its effectiveness in preventing migration by experimental comparison with commercially available esophageal covered stents.

MATERIALS AND METHODS

The following six types of stents were used: inner-covered Spiral Z-stents with diameters of 16 mm (small IC-SZ) and 19 mm (large IC-SZ), outer-covered Spiral Z-stent (OC-SZ), covered Wallstent, covered Ultraflex stent, and Cook Z-stent. Experimental models were prepared using clay to simulate stenosis of the esophagogastric junction or anastomosis site due to tumor, and each stent was placed in the clay. After the stent had been fully expanded with a balloon catheter, one of its ends was pulled until the stent migrated out of the clay, and the traction force was measured. The inner cavity of the stent placed in the clay was observed using an endoscope.

RESULTS

The mean maximal traction force required to pull the stents out of the clay were as follows, in decreasing order: 4.14 +/- 0.39 kg for the large IC-SZ, 4.12 +/- 0.83 kg for the small IC-SZ, 3.64 +/- 0.44 kg for the Cook Z-stent (p < 0.05), 3.34 +/- 0.62 kg for the covered Ultraflex stent (p < 0.05), 1.53 +/- 0.43 kg for the OC-SZ (p < 0.01), and 0.56 +/- 0.16 kg for the covered Wallstent (p < 0.01). The force required to pull out the large IC-SZ stent was the greatest, showing a significant difference from the values for the other four types of stents (excluding the small IC-SZ). Observation using an endoscope revealed that the wire of the IC-SZ stent was almost entirely embedded in the clay, whereas the wires of other stents were not.

CONCLUSION

The IC-SZ stent may be less likely to migrate than other esophageal covered stents.

Aortic stent-grafting with transrenal fixation: use of newly designed spiral Z-stent endograft

PURPOSE

To evaluate the feasibility and efficacy of a newly designed stent-graft placed across the renal arteries for exclusion of abdominal aortic aneurysms (AAAs) with short or tortuous proximal necks.

METHODS

Among a group of AAA patients treated with endovascular grafting, 5 had tortuous proximal necks and 13 had necks <20 mm (mean 13 mm). In these 18 cases, a 2- to 3-cm uncovered segment of the stent-graft was placed transrenally using a catheter inserted into the renal artery as a guide for graft margin positioning. A newly designed stent-graft was constructed from a custom-made spiral Z-stent covered with a thin-walled Dacron material; the endografts were deployed through 16-F (aortoaortic model) or 18-F sheaths (bifurcated devices). Renal function was assessed by preoperative and postoperative measurement of urea nitrogen and creatinine. Aneurysm exclusion and renal artery patency were evaluated during follow-up using spiral computed tomography and angiography.

RESULTS

The stent-grafts were correctly placed at the intended site in all 18 patients. Renal function was not affected except transiently in 1 patient who developed bilateral renal artery stenoses 24 hours after the procedure; Palmaz stents were deployed in each renal artery to reestablish satisfactory blood flow. Of the 33 renal arteries crossed by the bare stent-graft segment, all were patent over a mean 14-month follow-up (range 7-24), including the patient with Palmaz stents implanted for postprocedural renal stenosis. Complete aneurysm exclusion was maintained in 15 (83%) of 18 patients; proximal leaks persisted in 3 patients, including 2 with severely angled proximal necks.

CONCLUSIONS

Transrenal placement of the uncovered leading edge of custom-made spiral Z-stent-based endografts appears feasible and clinically effective in the treatment of AAAs with short or tortuous proximal necks.

Enhancement pattern of normal extraocular muscles in dynamic contrast-enhanced MR imaging with fat suppression

PURPOSE

To evaluate the internal structure of normal extraocular muscles on fat-suppressed dynamic contrast-enhanced MR imaging.

MATERIAL AND METHODS

Ten subjects were examined using fat-suppressed dynamic contrast-enhanced MR imaging. We evaluated the enhancement pattern (C-shaped or ring-like) of extraocular muscles and quantified the maximum ratios of enhancement (Rmax) and maximum ratios of signal increase (Vmax). We also quantified Rmax and Vmax in the central and peripheral portions of medial rectus muscles.

RESULTS

In the early phase of dynamic contrast-enhanced MR imaging, a C-shaped or ring-like pattern was observed in 100% of inferior rectus, 95% of medial rectus, 55% of superior rectus, 20% of lateral rectus, and 15% of superior oblique muscles. Overall mean Rmax and Vmax values showed statistically significant differences to the temporal muscles. For the peripheral portion of medial rectus muscles, mean Rmax and Vmax values were greater than for the central portion.

CONCLUSION

Using fat-suppressed dynamic contrast-enhanced MR imaging, the C-shape or ring-like internal structure of the extraocular muscles could be visualized, and were considered to reflect their structure of orbital and global layers. Potential usefulness of the fat-suppressed dynamic contrast-enhanced MR imaging for detecting pathological status is suggested.

Augmented prostaglandin E2 generation resulting from increased activities of cytosolic and secretory phospholipase A2 and induction of cyclooxygenase-2 in interleukin-1 beta-stimulated rat calvarial cells during the mineralizing phase

OBJECTIVE AND DESIGN

To assess prostaglandin (PG) E2 production by osteoblasts during the mineralizing phase after interleukin (IL)-1beta stimulation, using an in vitro system of rat calvarial cells cultured for 21 days.

METHODS

The cells, which reached confluence after 3 days, were designated day 0 cells. Culture was continued for a further 21 days after confluence. The cells on the 21st day of the culture were designated day 21 cells.

RESULTS

The PGE2 concentration in the medium of the day 21 cells was increased 72 h after IL-1beta treatment, and reached a peak level approximately 1,400 times that of the day 0 cells 6 h after IL-1beta treatment. We examined the effects of IL-1beta on PGE2 production and changes in the relevant enzyme activities, and found that the activities of cytosolic phospholipase A2 (cPLA2), type II secretory PLA2 (sPLA2) and cyclooxygenase (COX)-2 in the day 21 cells were increased. Both selective COX-2 inhibitor and cPLA2 inhibitor abolished PGE2 generation, whereas an sPLA2 inhibitor partially inhibited it. Taken together, these results indicate that COX-2 and cPLA2 play pivotal roles and sPLA2 is involved in IL-1beta-stimulated PGE2 production by these cells. Furthermore, we found that IL-Ibeta treatment induced PGE synthase activity and this correlated well with PGE2 production.

CONCLUSION

Augmented PGE2 production by mineralizing osteoblasts after IL-1beta treatment, and the involvement of IL-1beta-induced cPLA2, sPLA2, COX-2 and PGE synthase activities in this phenomenon were demonstrated.

Multimodality treatment for patients with hepatocellular carcinoma: a single institution retrospective series

BACKGROUND

The main therapeutic options for hepatocellular carcinoma (HCC) are hepatic resection, transcatheter arterial embolization (TAE), percutaneous ethanol injection therapy (PEIT) and regional chemotherapy (RC).

METHODS

This study retrospectively examined the results of primary treatment of 600 patients with hepatocellular carcinoma selected according to the treatment guidelines of our facility and the results of various combination therapies for recurrent cases. The selection criteria of therapeutic options included the number and size of tumours and hepatic function.

RESULTS

The selected primary treatment was hepatic resection for 53.7% of the cases, TAE for 31.5%, PEIT for 8.2% and RC for 6.6%,. The treatment for post-resection recurrence was TAE alone for 62.4% of the cases, TAE + RC for 4.0%, PEIT for 15.2%, TAE + PEIT alone for 4.8%, RC for 8.0% and hepatic resection for 5.6%. The treatment for post-TAE recurrence was TAE alone for 83% of the cases, TAE + PEIT for 9%, TAE + RC for 3%, RC alone for 3% and PEIT alone for 2%. For post-PEIT, therapy was PEIT alone for 71.4% of the cases and PEIT + TAE for 28.6%. For post-RC, RC alone was used for 92.5% and RC + PEIT for 7.5%. The cumulative 3 and 5-year survival rates were 84.4% and 70.6%, respectively for stage I; 61.5% and 48.6% for stage II; 52.7% and 20.5% for stage III; and 22.8% and 17.1% for stage IVA. The cumulative 5 and 7-year survival rates after the primary treatments were 52.% and 40.1%, respectively, for hepatic resection; 46.5% and 38.7%, for TAE; 49.6% and 33.1% for PEIT; and 16.7% and 8.3% for RC.

CONCLUSIONS

To improve the treatment results for HCC, early detection is essential and various modalities of treatments in combination should be used for recurrence after primary treatment.

Comparative distribution of GABAergic and peptide-containing neurons in the lateral lemniscal nuclei of the rat

By immunostaining, neurons expressing peptides (dynorphin and corticotropin-releasing factor, CRF) and glutamate decarboxylase (GAD), a GABA-synthesizing enzyme, were precisely mapped in the rat lateral lemniscal nuclei. While GAD neurons were numerous and preferably localized in the dorsal (DLL) and ventral (VLL) nuclei, neurons expressing these peptides were less numerous and localized primarily in the intermediate (ILL) nucleus of the lateral lemniscus. The ILL nucleus was shown to project to the inferior colliculus and to express Fos rapidly in response to peripheral acoustic stimulation, suggesting that the ILL nucleus may take part in non-GABAergic relay of acoustic information in the lateral lemniscus.

Numerous conglomerate inclusions in slowly progressive familial amyotrophic lateral sclerosis with posterior column involvement

A 59-year-old woman with slow progression of the loss of motor function and predominant lower motor manifestation during a 14-year period showed familial amyotrophic lateral sclerosis (fALS) with posterior column involvement, neuropathologically. Conglomerate inclusions (CIs) were observed in the remaining neurons in various areas, including the spinal anterior horn, posterior horn, Clark's column, accessory cuneate nucleus, tegmental reticular formation, motor nucleus of the trigeminal nerve, nucleus of the facial nerve, hypoglossal nucleus, medial nucleus of the thalamus, dentate nucleus, and motor cortex (Betz cells). Immunohistochemically, it was newly identified that the CIs showed marked immunoreactions with antibodies to phosphorylated and non-phosphorylated neurofilaments and to 64, 120, and 200 kD neurofilaments. The CIs were partially immunoreactive with the anti-ubiquitin antibody, although they reacted only weakly (or not at all) with anti-Cu/Zn superoxide dismutase (SOD1) antibody. Ultrastructurally, the CIs were comprised of neurofilaments. These data suggest that this case might have been different from an example of fALS with Ile 113 Thr mutation in the SOD1 gene.

Continuous arterial infusion therapy for severe acute pancreatitis: correlation between CT arteriography and therapeutic effect

PURPOSE

This study evaluates the relationship between the therapeutic effect of arterial infusion therapy for severe acute pancreatitis and drug distribution on CT-arteriography (CTA).

MATERIALS AND METHODS

Eleven patients with severe acute pancreatitis were treated by arterial infusion with use of protease inhibitor and antibiotics. Ten patients had an inflammation of the entire pancreas, while one had pancreatitis localized to the body and tail of the pancreas. The arterial infusion drugs were infused into the celiac artery, splenic artery, inferior pancreaticoduodenal artery, and common hepatic artery. The drug distributions were evaluated by CTA in 10 patients. The duration of arterial infusion ranged from 3 to 39 days. The relationship between the distribution on the CTA and the change in clinical grading of pancreatitis as evaluated by an APACHE II score was studied.

RESULTS

Of the nine patients with inflammation of the entire pancreas, six showed the distribution of contrast material to the entire area of pancreatic inflammation (a good distribution) on the CTA, and the remaining three did not show the distribution of contrast material to cover the entire area of pancreatic inflammation (a poor distribution). One patient with localized pancreatitis showed a good distribution. In seven patients with a good distribution, the APACHE II score was decreased from 11.7 points to 4.3 points during follow-up. In the remaining three patients with a poor distribution, the APACHE II score was decreased from 12.3 points to nine points, but was decreased to five points after the additional interventions. One patient without CTA showed a marked improvement in the APACHE II score. No clinically important complications were observed.

CONCLUSION

The present study findings suggest that arterial infusion is effective in the treatment of severe acute pancreatitis. A good drug distribution to the area of inflammation is needed to ensure a proper therapeutic effect.

Metabotropic glutamate receptor 2/3 immunoreactivity in the developing rat cerebellar cortex

In adult rat cerebellar cortex, the metabotropic glutamate receptors (mGluRs) 2 and 3 (mGluR2/3) are present in somata, dendrites, and terminals of Golgi cells as well as in presumed glial processes (Ohishi et al. [1994], Neuron 13:55-66). In the present study, spatiotemporal changes in immunostaining for mGluR2/3 were examined in postnatal rat cerebellar cortex. mGluR2/3-immunoreactive Golgi cell somata appeared first in the internal granular layer at postnatal day 3 (P3) and were restricted to lobules IX and X; however, by P5, they were present in all lobules. Immunoreactive Golgi cell axons were adult-like, appearing as tortuous fibers with clusters of varicosities. They were observed first in the internal granular layer at P7 and increased in number and complexity with time. It was confirmed that mGluR2/3-immunoreactive Golgi cell axon terminals belong to the synaptic glomerulus by P10. Immunoreactive Golgi cell dendrites extending into the molecular layer became prominent after P15. By that time, the immunostaining pattern was characteristic of Golgi cells, as seen typically in adults. Many intensely immunoreactive radial processes existed at birth (P0). These traversed the molecular and external granular layers, reaching the pial surface in every cerebellar lobule. Because they showed coimmunoreactivity for glial fibrillary acidic protein, they were confirmed to be Bergmann glial fibers. After P9, they began to lose immunoreactivity at the portion corresponding to the molecular layer, while an immunostained granular pattern appeared in that layer. Immunoreactive radial processes, however, remained in the external granular layer, and finally, at P21, they disappeared together along with the external granular layer. Granular staining in the molecular layer reached background levels at this time. These spatiotemporal changes in mGluR2/3 distribution suggested that there may be distinct roles for mGluR2/3 in Golgi cells and Bergmann glial cells during the early postnatal period. mGluR2/3 in Golgi cells might be associated closely with systemic maturation, whereas mGluR2/3 in Bergmann glia might be needed for neuron-glia interactions related to granule cell development.

Correlation between gamma-ray-induced G2 arrest and radioresistance in two human cancer cells

PURPOSE

The correlation between radioresistance and gamma-ray-induced G2 arrest was examined in two human cancer cell lines, HeLa (cervical carcinoma) and MeWo (melanoma).

METHODS AND MATERIALS

Cellular radioresistance was examined by a colony formation assay and Hoechst 33342 staining. G2 arrest induced by gamma-rays was examined by flow cytometry, and the accumulation of cyclin B1 and cdc2 proteins was analyzed using Western blotting.

RESULTS

HeLa was more resistant (10% survival dose[D10] = 10 Gy) than MeWo (D10 = 4 Gy) to gamma-rays. In HeLa, cell cycle analysis showed that G2 arrest was induced 10 or 24 h after irradiation of 10 or 4 Gy, respectively. In contrast, no clear G2 arrest in MeWo was observed after irradiation. Western blot analysis showed that cell cycle regulators, cyclin B1 and cdc2, were accumulated in HeLa but not in MeWo. The accumulation of cyclin B1 and cdc2 reached peak levels 24-34 h after irradiation of 10 Gy, and 24 h after irradiation of 4 Gy. In addition, Hoechst staining revealed similar increase in apoptotic bodies with time after irradiation in HeLa and MeWo at isosurvival doses.

CONCLUSION

Radioresistance of these human cancer cells is closely correlated with gamma-ray-induced G2 arrest, and cyclin B1 and cdc2 are possible regulators of G2 arrest.

Radical surgery for Budd-Chiari syndrome. Direct excision and repair for obstruction of the vena cava (Budd-Chiari syndrome) under hepatic vascular exclusion using a centrifugal pump

OBJECTIVE

To attempt to reduce the incidence of hepatic and cardiac failure after radical surgery for the Budd-Chiari syndrome.

DESIGN

Retrospective case study.

SETTING

University hospital, Japan

SUBJECTS

Three patients with obstruction of the vena cava (Budd-Chiari syndrome) by a thick membrane, thrombus, and a long stenosis, respectively.

INTERVENTION

Direct excision and repair by patch dilatation under hepatic vascular exclusion using a Biomedicus centrifugal pump.

RESULTS

Hepatic vascular exclusion provides good visibility and enables accurate assessment of the obstruction, proper treatment, and relatively little blood loss. There were no complications, particularly liver failure or heart failure, and the inferior vena cava stayed patent in all cases. Liver function was improved in all three patients.

CONCLUSION

This technique is safe and reliable for removal of obstruction of the inferior vena cava (Budd-Chiari syndrome).

Distribution of neurons expressing alpha 1G subunit mRNA of T-type voltage-dependent calcium channel in adult rat central nervous system

T-type voltage-dependent calcium channel has central roles in neuronal burst firing. The alpha1G subunit of T-type channel has been recently cloned and we here reported a cellular distribution of the alpha1G by in situ hybridization in adult rat brain and spinal cord. The cells expressing alpha1G were widely distributed in the central nervous system. The distribution seemed to be restricted to neurons, and exhibited a specific pattern in the cerebellum, thalamus, hippocampus and cerebral cortex.

Local coagulofibrinolysis in the postsurgical recovery of patients with chronic subdural haematoma

Postoperative recovery of patients with chronic subdural haematoma (CSH) was investigated by comparing pre- and postoperative coagulant and fibrinolytic activity in the haematoma contents of 15 patients with SCH. Patients in this study were treated draining the haematoma cavity without irrigation, a procedure dubbed the closed drainage. Haematomas were collected during, and 24 hrs after, surgery. Postoperative fibrinolytic activity was lower than that observed pre-operatively. In particular, levels of tissue plasminogen activator activity (TPA), and fibrin and fibrinogen degradation products (FDP) all decreased. In contrast, coagulant activity increased postoperatively. This paper will discuss the role of local coagulofibrinolysis in the postoperative recovery of CSH patients.

[Endovascular treatment of ruptured intracranial aneurysms using platinum coils in patients over 80 years of age]

Endovascular treatment of intracranial aneurysms using plantinum coils was performed in 10 patients over 80 years of age. The patients ranged in age from 81 to 96 years. Preoperative Hunt and Kosnik grading revealed one patient in grade I, 4 in grade II, 3 in grade III, and 2 in grade IV. The aneurysms were located in the internal carotid artery in 6 patients, in the anterior communicating artery in 1, and in the middle cerebral artery in 3 respectively. Intra-aneurysmal occlusion was accomplished in 8 patients with total or subtotal occlusion in 6 and partial occlusion in 2. In one patient with a peripheral middle cerebral artery aneurysm, the parent artery was occluded just proximal to the aneurysm. In the remaining one patient in grade III, an aneurysm associated with wide neck could not be occluded because of coil protrusion into the parent artery. In 9 patients who were successfully treated, all five patients in grade I or II and one in grade III resulted in good outcome, but the other three patients in grade III and IV showed poor outcome. No evidence of recurrent hemorrhage was noted during the follow-up period ranging from 2 months to 4 years. Endovascular coil embolization is a useful therapeutic alternative for treating ruptured intracranial aneurysms in patients over 80 years of age, especially those in Grade I or II.

Estimation of regional lung function in interstitial pulmonary disease using 99mTc-technegas and 99mTc-macroaggregated albumin single-photon emission tomography

For quantitative evaluation of the regional lung function in patients with interstitial pulmonary disease (IP) in the sitting position, 99mTc-Technegas and 99mTc-macroaggregated albumin (MAA) single-photon emission tomography (SPET) studies were performed in 12 healthy controls (HC) and 42 IP patients. Four transverse images were prepared from the data obtained and designated as slices no. 1-4 from the top downward. Regions of interest (ROIs) were determined in the anterior and posterior parts of the lung in each slice, and the ratio of the count per voxel in the ROIs to the count in the entire lung was calculated as the regional Technegas index (T). The regional perfusion index (Q) was calculated by a similar procedure using the data of 99mTc-MAA SPET. The ratios between T and Q (T/Q) in the anterior and posterior regions of the lung, and the ratios of T and Q between the anterior and posterior regions of the lung (Tp/Ta and Qp/Qa) were examined. In the HC group, T/Q decreased but Tp/Ta and Qp/Qa increased from the upper to the lower lung fields. When IP patients were classified into (I) those in whom T/Q decreased from the upper to the lower lung fields, (II) those in whom it was similar in all slices, (III) those in whom it increased from slice 3 to slice 4, and (IV) those in whom it increased from slice 2 to slices 3 and 4, this classification was more closely correlated with %VC than with %DLCO or PaO2. When the patients were classified according to Tp/Ta and Qp/Qa into (A) those in whom the values were greater in the lower than the upper lung field, (B) those in whom the values were similar in all slices, and (C) those in whom the values were smaller in lower than in upper lung fields, categories B and C were observed frequently even in patients whose %VC was in the normal range. This method is considered to be an effective means to evaluate the progression and pathology of IP and to detect early impairment of lung function.

Efficacy of Palmaz Stent Deployment for Subclavian Artery Stenosis

Percutaneous angioplasty is a useful method for improvement of posterior circulation of the brain in subclavian artery stenosis and occlusion. Recently, the Palmaz stent was introduced for peripheral vessels stenosis. We evaluated the efficacy and care point of Palmaz stent deployment for subclavian artery stenosis in seven cases (5 stenosis and 2 occlusion) with symptoms and a mean age of 65.1 years. The stents could be deployed exactly at the stenotic region in all cases.

The pressure gradient disappeared in all cases, and the clots were fixed between vessel wall and stent. Antegrade circulation and significant clinical symptoms improvement were obtained in all cases. In angioplasty of subclavian artery stenosis, as compared with balloon angioplasty alone, Palmaz stent is a very useful device with fewer complications including distal thrombosis of the vertebrobasilar circulation.

Ultrasonographic screening for arterial occlusive disease in the pelvis and lower extremities

PURPOSE

To evaluate the accuracy of pulsed Doppler ultrasound (PDUS) and color Doppler ultrasound (CDUS) for the screening of arterial occlusive disease in the pelvis and lower extremities.

METHODS

We studied 52 patients with intermittent claudication or lower extremity "coolness." Pulsed Doppler waveforms were measured in the inguinal and popliteal regions and were classified according to their pattern. Patients with abnormal waveforms underwent subsequent CDUS evaluation from the aortic bifurcation to the popliteal arteries. All patients also underwent conventional angiography.

RESULTS

All stenoses (> 50%) and occlusions on angiography were detected by PDUS. The combination of PDUS and CDUS allowed detection of 78.0% of stenotic lesions (> 50% narrowing) and 96.6% of occlusive lesions in the iliofemoral regions and in 100% of stenotic lesions (> 50% narrowing) and occlusive lesions in the femoropopliteal regions. PDUS required approximately 3 min. About more 5 min are required when CDUS was added.

CONCLUSION

Combined PDUS and CDUS appears to be a rapid, highly sensitive means of screening for arterial occlusive disease in the pelvis and lower extremities.