Can CT predict the development of oroantral fistula in patients undergoing maxillary third molar removal?

PURPOSE

In maxillary wisdom tooth extraction, the necessity of CT is unknown. The purpose of this study was to investigate whether CT adding to orthopantomography is useful for predicting oroantral perforation during maxillary third molar extraction.

METHODS

Various risk factors for oroantral perforation during maxillary third molar extraction were investigated by univariate and multivariate analyses. We analyzed those of all patients and the patients who underwent CT, respectively. The proximity of the roots to the maxillary sinus floor (root-sinus [RS] classification) and Archer classification were assessed using panoramic radiography. The number of roots and vertical relationship were assessed using CT.

RESULTS

A total of 604 out of 3299 patients underwent CT adding to orthopantomography. In all cases, multivariate analyses except for CT findings showed that the RS classification type III/IV and the Archer classification Type B/C/D in panoramic findings were significantly correlated with oroantral perforation as radiological findings. In cases for which CT was performed, multivariate analyses showed that one root (OR 12.87) and the vertical relationship Type D (OR 5.63) in CT findings, besides the RS classification type III/IV (OR 4.47) in panoramic findings, were significantly related to oroantral perforation.

CONCLUSION

The RS classification and the Archer classification in panoramic findings can predict the risk of oroantral perforation. The usefulness of CT adding to orthopantomography is limited. However, when the relationship between the upper wisdom tooth and maxillary sinus floor (RS classification) is unclear, to check whether the number of roots is one and the apex of one root is projecting into the maxillary sinus in CT findings, is useful for the prediction.

High resolution x-ray absorption and emission spectroscopy of Li x CoO2 single crystals as a function delithiation

The effect of delithiation in Li _x CoO₂ is studied by high resolution Co K-edge x-ray absorption and x-ray emission spectroscopy. Polarization dependence of the x-ray absorption spectra on single crystal samples is exploited to reveal information on the anisotropic electronic structure. We find that the electronic structure of Li _x CoO₂ is significantly affected by delithiation in which the Co ions oxidation state tending to change from 3+  to 4+. The Co intersite (intrasite) 4p-3d hybridization suffers a decrease (increase) by delithiation. The unoccupied 3d t _2g orbitals with a _1g symmetry, containing substantial O 2p character, hybridize isotropically with Co 4p orbitals and likely to have itinerant character unlike anisotropically hybridized 3d e _g orbitals. Such a peculiar electronic structure could have significant effect on the mobility of Li in Li _x CoO₂ cathode and hence the battery characteristics.

Efficacy of pimobendan on survival and reoccurrence of pulmonary edema in canine congestive heart failure

The aim of this study was to evaluate the efficacy of pimobendan with conventional therapies on survival and reocurrence of pulmonary edema in dogs with congestive heart failure (CHF) caused by myxomatous mitral valve disease (MMVD). Records of 197 client-owned dogs from 14 veterinary hospitals were included in this study. Dogs were administered conventional treatments with or without pimobendan. Sixty-four dogs received a standard dose of pimobendan (0.20-0.48 mg/kg every 12 hr (q12hr)), 49 dogs received a low dose of pimobendan (0.05-0.19 mg/kg q12hr), and 84 dogs received conventional therapy alone. Dogs in the standard-dose and low-dose pimobendan groups had significantly longer median survival times than dogs in the conventional group (334, 277 and 136 days, respectively; P<0.001). The reoccurrence rate of pulmonary edema in the standard-dose group was significantly lower than in the low-dose and conventional groups (43%, 59% and 62%, respectively; P<0.05). Combination of pimobendan with a conventional treatment regimen significantly prolonged survival time after an initial episode of pulmonary edema in dogs with CHF caused by MMVD. There was no difference in survival between dogs administered standard and low doses of pimobendan, but pimobendan did prevent the reoccurrence of pulmonary edema in a dose-dependent manner.

A multi-centre retrospective study of mandibular fractures: do occlusal support and the mandibular third molar affect mandibular angle and condylar fractures?

This retrospective study was performed to investigate the influence of occlusal support and the presence, state, and position of mandibular third molars on the incidence of mandibular angle and condylar fractures. The following variables were investigated: age, sex, cause of fracture, presence and state (impaction, angulation, and the number of roots) of the mandibular third molars, site of the mandibular fracture, presence of occlusal support, duration of intermaxillary fixation, and postoperative complications. Various risk factors for mandibular angle and condylar fractures were investigated by univariate analysis. The risk of mandibular angle fracture was significantly higher in patients with occlusal support and mandibular third molars. The risk of condylar fracture was significantly higher in patients without occlusal support or mandibular third molars. The position and angulation of the mandibular third molars were not significant risk factors in mandibular angle and condylar fractures. This study demonstrated the influence of occlusal support and the presence of mandibular third molars on the incidence of mandibular angle and condylar fractures. The presence of occlusal support may be a more important factor affecting mandibular angle or condylar fractures than the position of the mandibular third molars.

Effectiveness of photocoagulation using an Nd:YAG laser for the treatment of vascular malformations in the oral region

OBJECTIVE

The purpose of this study is to make a clinical evaluation of vascular malformations in the oral region treated by photocoagulation with an Nd:YAG laser, to determine its effectiveness.

BACKGROUND DATA

The Nd:YAG laser, with a wavelength of 1064 nm in the near-infrared part of the electromagnetic spectrum, has unique characteristics, such as absorption by oxygenated hemoglobin, negligible absorption by water, and a deep depth of penetration, all of which are ideal for performing the photocoagulation of vascular malformations.

METHODS

The subjects were 67 patients (69 cases) with vascular malformations in the oral region who visited our hospital from 2004 to 2011, and were treated by photocoagulation using an Nd:YAG laser. They consisted of 23 male patients and 44 female patients, ranging from 7 to 89 years of age. Lesion size was classified for convenience into two groups (<15 mm or ≥ 15 mm) for clinical analysis and evaluation. The lesions were located at sites including the lip, tongue, buccal mucosa, gingiva, mouth floor, and soft palate, and ranged in size from 3 to 42 mm along the major axis. Fifty patients (74.6%) were treated on an outpatient basis, whereas 17 patients (25.4%) were treated in the hospital. All patients were treated using an Nd:YAG laser at an output of 8-15 W under local anesthesia.

RESULTS

No patient developed serious complications from this treatment. However, it was necessary to irradiate the laser beam two or more times in cases of deep-seated lesions.

CONCLUSIONS

We were able to obtain satisfactory results without clinical complications, using only external irradiation. These results suggest that the Nd:YAG laser is effective for the treatment of vascular malformations in the oral region.

Impact of lithium-ion ordering on surface electronic states of Li(x)CoO2

Li(x)CoO(2) exhibits intriguing electronic properties due to a strong electron correlation and complex interplay between Co and Li ions. However, fundamental understanding of the nanoscale distribution of Li ions and its effect on the electronic properties remains unclear. We use scanning tunneling microscopy and density functional theory to elucidate the degree of Li(x)CoO(2) surface electronic state modification that can be achieved by Li ordering. The surface Li ions are highly mobile and preferentially form a (1 × 1) hexagonal lattice, whereas the surface CoO(2) layer shows metallic and insulating phases, indicating the coexistence of ordered and disordered Li ions in the subsurface layer. These results provide evidence of novel electronic properties produced by spatially inhomogeneous Li-ordering patterns.

Role of oxygen holes in Li(x)CoO(2) revealed by soft X-ray spectroscopy

The fundamental electronic structure of the widely used battery material Li(x)CoO(2) still remains a mystery. Soft x-ray absorption spectroscopy of Li(x)CoO(2) reveals that holes with strong O 2p character play an essential role in the electronic conductivity of the Co(3+)/Co(4+) mixed valence CoO(2) layer. The oxygen holes are bound to the Co(4+) sites and the Li-ion vacancy, suggesting that the Li-ion flow can be stabilized by oxygen hole back flow. Such an oxygen hole state of Li(x)CoO(2) is unique among the various oxide-based battery materials and is one of the key ingredients to improving their electronic and Li-ion conductivities.

Bcl-2 gene prevents induction of apoptosis in l1210 murine leukemia-cells by sn-38, a metabolite of the camptothecin derivative cpt-11

New camptothecin (CPT) derivatives have recently been synthesized following the finding that CPT has strong antitumor activity due to its inhibition of topoisomerase I through the formation of stable topoisomerase I-DNA cleavable complexes, but has not been clinically used due to its pronounced toxicity. 7-ethyl-10-hydroxy-CPT (SN-38), a metabolite of the CPT derivative 7-ethyl-10-[4-(1-piperidino)-1-piperidino] carbonyloxy-CPT(CPT-11), plays an essential role in mediating the antitumor effect of CPT-11. However, the reasons for the cytotoxicity of SN-38 remain unclear. In this study, we demonstrated using results of DNA fragmentation assay and cell cycle analysis that SN-38 and CPT both induce apoptosis in L1210 murine leukemia cells. We demonstrated in addition that enforced expression of the bcl-2 gene in L1210 cells by MPZenNeo (bcl-2) retroviral gene transfer increased resistance to the apoptosis induced by SN-38 and CPT. These findings suggest the possibility that the bcl-2 gene impedes the activity of a common pathway for apoptosis induced by SN-38 and CPT.

Maxillary sinus floor elevation combined with a vertical onlay graft

We performed maxillary sinus floor elevation combined with a vertical onlay graft for a total of 11 sides of nine patients (1 woman and 8 men) in our Hospital. On CT, the preoperative minimum alveolar bone thickness with a mean of 1.8 mm was improved to 15.3 mm within a month after this surgery. A total of 20 dental implants were placed and there was only one failed implant. With the average follow-up of 15.6 months, an average of 3.4 mm of bone absorption was found in the site of the maxillary sinus and 1.1 mm in the site of the onlay graft. The crown-implant ratio in all cases was within the permissible range. Consequently, this bone augmentation surgery was considered to be useful.

Analysis of the 619 Brånemark System TiUnite implants: a retrospective study

The purpose of this retrospective study was to determine the outcome of Brånemark System TiUnite® implants (Nobel Biocare/Sweden), and to identify the risk factors associated with implant failure. A total of 151 patients (83 maxillae and 91 mandibles) received 619 implants from July 2003 until May 2010. The patients included 86 males and 65 females, with a median age of 51.6 years and an age range of 16 to 90 years at the time of implant surgery. Seventeen maxillae and 16 mandibles were completely edentulous, and 66 maxillae and 75 mandibles were partially edentulous. All the patients were followed until June 2011. Among the 619 implants, 9 maxillary implants and 8 mandibular implants were unsuccessful. The overall survival rate was 96.82%. A logistic regression analysis identified that a history of steroid treatment, application of a dento-maxillary prosthesis, a lack of mechanical coupling between the implants, and the length of the implants (≤8.5mm) were significant predictors of implant failure.

Effects of calcium phosphate cement on the peripheral nerve fibers

Calcium phosphate cement (CPC) is a bioactive ceramic substance. To clarify the effects of CPC on the peripheral nerve, we applied CPC on the peripheral nerve fibers of experimental animals and investigated the nerve fibers by electron microscopy and by immunoblotting analysis using an anti-myelin-associated glycoprotein (anti-MAG) antibody. The results showed that there was neither axonal sprouting at the nodes of Ranvier nor down-regulation of MAG beyond the normal level in the nerve fibers. These findings suggest that there is no harm in using CPC near the peripheral nerve fibers.

Analysis of 472 Brånemark system TiUnite implants:a retrospective study

PURPOSE

The purpose of this retrospective study was to determine the success of Brånemark System TiUnite implants (Nobel Biocare/Sweden) placed in partially or completely edentulous jaws restored with fixed or removable prostheses.

PATIENTS AND METHODS

A total of 131 jaws from 110 patients (64 maxillae and 67 mandibles) received 472 implants from July 2003 until March 2008. The patients included 57 men and 53 women, with a median age of 49.6 years and an age range of 16 to 90 years at the time of implant surgery. Twelve maxillae and 10 mandibles were completely edentulous, and 52 maxillae and 57 mandibles were partially edentulous. A single implant was placed in 21 jaws (10 maxillae and 11 mandibles), while multiple implants were placed in the other patients. Among the 131 jaws, removable prostheses were mounted in 10 maxillae and 8 mandibles, and the other jaws were restored with fixed prostheses.

RESULTS

Among the 472 implants, 6 maxillary implants and 5 mandibular implants were unsuccessful. The success rate for the implants was 96.56% (96.07% in the maxillae and 97.18% in the mandibles).

Ror2 expression in squamous cell carcinoma and epithelial dysplasia of the oral cavity

In this study, the expressions of Ror2 in the normal mucosa, the epithelium dysplasia, and squamous cell carcinoma (SCC) of the oral cavity were investigated, and possible differences in the expression patterns of Ror2 and of p53, Ki67, or PCNA were examined. In Western blotting analyses, Ror2 expression in oral cancer was significantly higher than that in the normal oral mucosa. Immunohistochemically, Ror2 was localized on the plasmalemma and in the rough endoplasmic reticulum (rER). The tissue area with an Ror2-positive expression tended to differ from the area with a positive expression of p53, ki67, or PCNA, and the number of cells with an Ror2 expression tended to increase as the degree of malignancy rose in the epithelial tissues. These results suggest that Ror2 was not related to cell proliferation, but rather associated with cell polarity and cell motility, and that it was also closely associated with the degree of malignancy in oral epithelial tissue.

Expression of beta-catenin and integrin-linked kinase in the mouse sciatic nerve

In the present study, the expressions of beta-catenin and integrin-linked kinase (ILK) in the adult mouse peripheral nerve were investigated by means of immunoblotting analyses and electron microscopy using the immunogold pre -embedding method. As a result, beta-catenin and ILK were shown to be expressed both in the axon and the Schwann cell of the myelinated and unmyelinated fibers. By electron microscopy, some molecules of beta-catenin and ILK tended to concentrate under the axolemma in the unmyelinated fibers, while these molecules were distributed in a scattered form throughout the axoplasm in the myelinated fibers. Concerning the cytoplasm of the Schwann cells, the loop region was too slender to detect whether beta-catenin and ILK were associated with the plasmalemma; however, beta-catenin and ILK were distributed diffusely without any relationship in regard to the plasmalemma or the cell organelles around the nucleus region. The density of beta-catenin and ILK around the nucleus region was greater than that within the nucleus region. From these results, some molecules of beta-catenin mediate the axon-Schwann cell adhesion of the unmyelinated fibers, while other molecules are thought to be separated from the cadherin-catenin complex on the plasmalemma. Accordingly, it is hypothesized that the cell-cell adhesion property in the peripheral nerve is not strong but dynamic, and this adhesion is possibly regulated by ILK.

Increased Urinary Kallikrein-Like Activity in the Syndrome of Inappropriate Secretion of Antidiuretic Hormone

The role of the kallikrein system in the natriuresis of SIADH was studied in 3 patients. Following free water intake, serum Na decreased. Urinary Na excretion, urinary aldosterone excretion and urinary kallikrein-like activity (UKaV) increased. Significant relationships were observed between UKaV and urinary aldosterone excretion during the study. Further, there were significant relationships between serum Na and UKaV, and between uric acid clearance and UKaV. In 1 patient, who was observed for a longer period, a significant relationship was observed between Na clearance and UKaV. We conclude that UKaV is increased during hyponatremia in SIADH by volume expansion. This increase in UKaV may play a role in the natriuresis in SIADH.

Two cases of masticator space abscess initially diagnosed as temporomandibular joint disorder

Diseases causing trismus or pain of the temporomandibular joint (TMJ) include temporomandibular joint disorders (TMJD), trauma, tumors and an inflammation. This report describes two cases of masticator space abscesses causing trismus and TMJ pain, which were initially diagnosed as TMJD. The first case was a 62-year-old female suffering from trismus and right-TMJ pain without swelling or redness, which was diagnosed as TMJD with MRI (TMJ region) findings of bilateral anterior disc displacement without reduction. However, five days later the right-TMJ pain became more severe and MRI (maxillofacial region) revealed a right masticator space abscess. She was treated with antibiotics and underwent an intraoral incision following hospitalization. She recovered well and was discharged from the hospital on the 15th day. The second case was a 68-year-old female having trismus and left-TMJ pain, which was diagnosed as TMJD at another hospital. She received instructions for jaw opening training, but visited our hospital because her symptoms were not improved. At the first visit, the mouth opening range was 18 mm and an anterior dislocation of the left condylar process was found by X-ray imaging. CT-scan revealed an abscess in the left masticator space. Therefore an intraoral incision was performed under general anesthesia and antibiotics were administered. She recovered well and was discharged from hospital on the 12th day. When we treat TMJD, we must keep in mind the possibility of the inapparent presence of some unseen inflammation, especially an abscess formation in the masticator space.

Myofibroma of the mandible

This article is reporting a case of myofibroma involving the mandible of a 12-year-old boy. The patient did not have any swelling nor any redness but of partial mental nerve hypoesthesia. A panoramic radiograph demonstrated a globe like radiolucent lesion in the left angle of the mandible that was an increased uptake spot by FDG-PET. Incisional biopsies indicated myofibroma, therefore the tumor was totally resected under general anesthesia. After surgery there was no complication except for a change for the worse of unilateral mental nerve hypoesthesia. At 29 months postoperative, no evidence of recurrence could be found.

Alveolar ridge augmentation using various bone substitutes--a web form of titanium fibers promotes rapid bone development

Alveolar ridge augmentation with beta-tricalcium phosphate (beta-TCP) granules, calcium phosphate cement (CPC) powder and web form of titanium fibers (TW) added to Platelet-Rich-Plasma (PRP) was histologically observed for 5 months by the experiments using the maxilla of rabbits. As a result, TW was thus found to promote the rapid bone development within a period of less than 5 months, because TW had an appropriate gap between the titanium fibers for new bone progression. However, titanium fibers remained intact within the maxilla. The CPC powder was transformed into dense cement and also remained intact in the bone. These residual materials must be obstacles to perform the placement of dental implants. On the other hand, beta-TCP granulations were gradually replaced by the new bone, but this process took about 5 months to be completed. Consequently, for an ideal alveolar bone substitute, there needs to be a suitable gap formation within the substitute, such as TW, and properties of total bone replacement, such as that seen in beta-TCP granules.

A clinical study of temporomandibular joint disorders -an analysis based on the Japanese subtype classification-

In this study, cases of temporomandibular joint disorder (TMJD) were analyzed based on the subtype classification established by Japanese Society for the Temporomandibular Joint (JSTMJ) in 2001. The subject of our investigation consisted of cases who visited to the department of Oral and Maxillofacial Surgery of Kobe University Hospital in 2002 because of TMJD. Among them, any cases with no physical examination or strong psychogenic factors related to their symptoms were excluded. As a result, a total of 195 cases were investigated in this study. These cases consisted of 50 males and 145 females with a mean age of 38.1 years, and they were classified as type I (28 cases), type II (7 cases), type IIIa (91 cases), type IIIb (44 cases) and type IV (25 cases). The most frequently used therapy of the all diagnostic categories was a stabilization type of splint therapy (99 cases), and medication with muscle relaxants (52 cases) or analgesics (50 cases) ranked thereafter. All cases were followed until December 2004, and the results of the treatment were classified into 5 categories of 'improved', 'effective', 'no change', 'deteriorated' and 'discontinued'. No cases with a deterioration of symptoms were observed, while 109 cases (55.9%) were assessed as either 'improved' or 'effective'.

Durable molecular complete remission induced by low-dose imatinib plus low-dose interferon alpha in a patient with chronic myelogenous leukaemia

A 50-year-old male was diagnosed with chronic myelogenous leukaemia (CML) in chronic phase in March 2000. He was treated initially with hydroxyurea, administered orally. This was changed to interferon alpha (IFN) 5 million units (5 MIU) subcutaneously daily in May 2000; complete cytogenetic response was achieved 11 months later. IFN dosage was reduced to 5 MIU, alternate days, in June 2001 and a cytogenetic relapse occurred 3 months later. Since April 2002, he has received IFN 5 MIU three times weekly in combination with imatinib 200 mg/day. The Philadelphia chromosome disappeared from his peripheral blood cells in July 2002 and a complete molecular response was achieved in January 2003. Serial molecular studies between January 2004 and January 2005 showed no detectable major BCR/ABL chimeric transcript. Grade 2 neutropenia and grade 1 non-haematological adverse effects have been observed. This case report suggests the combination of low-dose imatinib and IFN would be tolerable and effective for CML patients in chronic phase.

A case of reversed pituitary dysfunction with intrasellar mass

Hypopituitarism can be caused by tumor, inflammation, granuloma and injuries. Once pituitary function is disturbed, hormone replacement therapy is necessary for the remaining life span in most cases. We have experienced a rare case of a unique intrasellar mass associated with pituitary dysfunction in which both spontaneously reversed. A 61-yr-old woman developed hypoadrenalism and central diabetes insipidus (cDI). Magnetic resonance (MR) imaging revealed a lobular, strong hypointense lesion with spotty signal in the middle of the hypophysis. This spotty lesion showed isointensity on T1- and high-intensity on T2-weighted MR images. The spotty signal as well as the normal pituitary lobe were enhanced by the administration of gadolinium. As replacement therapies for hypoadrenalism and cDI, 10 mg of hydrocortisone and 2.5 microg of desmopressin acetate were prescribed. Three months later, slight shrinkage of intrasellar mass and spontaneous improvement of pituitary functions were found. Hydrocortisone was then discontinued. Furthermore, because polyuria and polydipsia were improved nine months later, desmopressin acetate was stopped. Currently, the intrasellar mass continues to shrink, and the patient shows no symptoms without medication. Based upon the unique features of MR images, we suspect that the origin of the mass is an intrasellar hemangioma.

Ultrastructural localization of alpha E-catenin in the rat sciatic nerve

Alpha E-catenin is included in the same category as alpha N-catenin, and both of them have been identified as subtypes of alpha-catenin. A previous study issued from our laboratory demonstrated that alpha N-catenin is localized in the axoplasm of unmyelinated peripheral nerves, whereas the localization of alpha E-catenin in the peripheral nervous system has not yet been reported. The present study was focused on the distribution of alpha E-catenin in the rat sciatic nerve. By electron microscopy using immunocytochemical methods, alpha E-catenin immunoreactivities were generally detected in the Schwann cell cytoplasm of unmyelinated nerve and the outer loop of myelinated nerve. Those findings suggest that alpha E-catenin may be associated with Schwann cell-Schwann cell or axon-Schwann cell contacts.

WT1 expression level and clinical factors in multiple myeloma

Although Wilm's Tuomor gene (WT1) was first identified as a tumor suppressor gene for Wilm's tumor, WT1 overexpression has been detected in different malignant cell types including leukemia. Increased expression of WT1 in acute leukemia is potentially used as a marker of minimal residual disease. However, the significance of the gene for multiple myeloma is still not clear. To determine the clinical relevance of WT1 expression in multiple myeloma, we examined the association of clinical parameters and WT1 expression in bone marrow for 17 newly diagnosed multiple myeloma patients. WT1 was assessed by real-time quantitative polymerase chain reaction (RQ-PCR) and calculated standardized WT1 expression level per 100 plasma cells in the bone marrow specimen as "corrected WT1". The expression of standardized WT1 and corrected WT1 in myeloma was 59 to 1,600 copies/microg RNA and 0.05 to 406.3 copies/microg RNA/100 plasma cells, respectively, lower than in leukemia. WT1 transcripts increased when clinical factors worsen, including the stage, amount of M protein, Hb, platelet count, blood urea nitrogen (BUN), creatinine, serum alkaline phosphatase (ALP), calcium, beta2-microglobulin, thymidine kinase activity (TK), and C-reactive protein (CRP). In conclusion, the expression level of WT1 could be an additional marker to the standard parameters considered in risk assessment for multiple myeloma.

N-/R-cadherin expression in dorsal root ganglia and spinal cord

Localizations of N- and R-cadherins in dorsal root ganglia and lumbar spinal cord of the chick were immunocytochemically examined. As a result, N- and R-cadherin appeared to be co-localized on plasmalemma of neurons in dorsal root ganglia that were in contact with satellite cells, whereas there was no expression in neurons of the ventral horn. These findings indicate the possibility that expression pattern of cadherins in the peripheral neuron differs with its functional property (e.g. sensory or motor).

Induction therapy by frequent administration of doxorubicin with four other drugs, followed by intensive consolidation and maintenance therapy for adult acute lymphoblastic leukemia: the JALSG-ALL93 study

In order to improve the disappointing prognosis of adult patients with acute lymphoblastic leukemia (ALL), we applied similar induction therapy as that used for acute myeloid leukemia (AML), ie frequent administration of doxorubicin (DOX). DOX 30 mg/m(2) was administered from days 1 to 3 and from days 8 to 10 together with vincristine, prednisolone, cyclophosphamide and L-asparaginase, followed by three courses of consolidation and four courses of intensification. From December 1993 to February 1997, 285 untreated adult patients with de novo ALL were entered. Of 263 evaluable patients (age 15 to 59; median 31), 205 (78%) obtained complete remission (CR). At a median follow-up period of 63 months, the predicted 6-year overall survival (OS) rate of all patients was 33%, and disease-free survival (DFS) rate of CR patients was 30%, respectively. By multivariate analysis, favorable prognostic factors for the achievement of CR were age <40 and WBC <50 000/microl; for longer OS were age <30 and WBC <30 000/microl; and for longer DFS of CR patients were FAB L1 and ALT <50 IU/l. Among 229 patients who had adequate cytogenetic data, 51 (22%) had Philadelphia (Ph) chromosome. Ph-negative chromosome was a common favorable prognostic factor for CR, longer OS and DFS. DFS was not different between early sequential intensification (n = 48) and intermittent intensification (n = 43) during the maintenance phase. Among CR patients under 40 years old, the 6-year survival was not different between the allocated related allo-BMT group (34 patients) and the allocated chemotherapy group (108 patients). However, among patients with Ph-positive ALL, the survival of patients who actually received allo-BMT was superior to that of patients who received chemotherapy (P = 0.046).

Analysis of 20-year follow-up study of LVP regimen for adult acute lymphoblastic leukemia

In an attempt to develop a new intensive chemotherapy for adults with untreated acute lymphoblastic leukemia (ALL), 3 sequential programs were designed for 62 patients (age range, 15 to 74 years; median age, 32 years) consisting of the LVP-79 (1979-1984, 27 patients), LVP-85 (1984-1986, 14 patients), and LVP-87 (1987-1989, 21 patients) regimens. The influence of clinical and biologic characteristics on the patient outcome was also examined. L-asparaginase (L-asp), vincristine, and prednisolone, defined collectively as LVP, were administered for induction chemotherapy in all protocols. After achieving complete remission (CR), patients underwent 2 years of multi-agent consolidation, intensification, and maintenance therapy consisting of various combinations. No significant differences were noted between the 3 groups regarding CR rate or survival. In total, 47 of 62 patients (75.8%) achieved CR. The median overall survival (OS) and median CR durations were 550 days and 341 days, respectively. Overall, the estimated survival rate at 20 years was 18.1%. The disease-free survival rate at 20 years was 26.2%. According to univariate analysis, the most favorable pretreatment characteristic for achieving CR was age. A younger age (<40 years of age), platelet count >30 x 10(9)/L, having L1 morphology (French-American-British [FAB]classification subtype), female sex, and the absence of chromosomal abnormalities also helped improve survival rate. According to multivariate analysis, presence of Ph chromosome was found to be a major influencing factor for OS. Although higher doses of L-asp were administered than those used in previous studies, the adverse effect of L-asp was rarely identified. Therefore, it should be considered one of the key drugs for treatment of adult ALL. Further strategies still need to be developed to obtain better survival in adult ALL.

Effects of sodium hyaluronate on epithelial healing of the vesical mucosa and vesical fibrosis in rabbits with acetic acid induced cystitis

PURPOSE

To evaluate the effect of sodium hyaluronate on epithelial healing of the vesical mucosa and vesical fibrosis, and clarify the effect of the sodium hyaluronate solution concentration, we administered sodium hyaluronate in the bladder of rabbits with acetic acid induced cystitis.

MATERIALS AND METHODS

Sodium hyaluronate at 3 concentrations (0.1%, 0.2% and 0.4%) was injected intravesically into rabbits with cystitis. Seven days after injection the effect of sodium hyaluronate was evaluated by bladder capacity measurement. Furthermore, the epithelial defective region of the mucosal membrane and bladder dry weight were determined and the condition of the epithelial membrane and extent of fibrosis were examined histologically.

RESULTS

In all sodium hyaluronate treated groups a significant improvement in bladder capacity was observed compared to controls. In addition, a significant reduction was noted in the area of the epithelial defective region in the groups treated with 0.2% or 0.4% sodium hyaluronate and a significant decrease was noted in bladder dry weight in the group treated with 0.4% sodium hyaluronate. Histological examination revealed accelerated epithelial healing of the vesical mucosa and inhibited vesical fibrosis in the group treated with 0.4% sodium hyaluronate.

CONCLUSIONS

Our findings suggest that sodium hyaluronate is effective for promoting epithelial healing of the vesical mucosa and inhibiting vesical fibrosis.

Diffusion of nodal signaling activity in the absence of the feedback inhibitor Lefty2

The role of Lefty2 in left-right patterning was investigated by analysis of mutant mice that lack asymmetric expression of lefty2. These animals exhibited various situs defects including left isomerism. The asymmetric expression of nodal was prolonged and the expression of Pitx2 was upregulated in the mutant embryos. The absence of Lefty2 conferred on Nodal the ability to diffuse over a long distance. Thus, Nodal-responsive genes, including Pitx2, that are normally expressed on the left side were expressed bilaterally in the mutant embryos, even though nodal expression was confined to the left side. These results suggest that Nodal is a long-range signaling molecule but that its range of action is normally limited by the feedback inhibitor Lefty2.

Marked hypotensive and blood flow-increasing effects of a new lipo-PGE(1) (lipo-AS013) due to vascular wall targeting

Lipo-AS013 is being developed as an improved formulation of lipo-PGE(1), which is widely used in clinical practice in Japan and some Asian countries. We have previously reported that lipo-AS013, which is a lipid microsphere (LM) preparation of a chemically stable and lipophilic PGE(1) prodrug (AS013, Fig. 1), slowly releases small amounts of the active ingredient (AS013) in human plasma. In the present study, to estimate the vascular wall targeting ability and efficacy of lipo-AS013, we determined the hypotensive and blood flow-increasing effects of lipo-AS013, lipo-PGE(1), PGE(1)CD, and AS013. Lipo-AS013 was found to have longer-lasting hypotensive and blood flow-increasing effects than the other agents. The two LM preparations, lipo-PGE(1) and lipo-AS013, had a markedly stronger effect than PGE(1)CD and AS013 alone, demonstrating the benefit of drug delivery using LM. In spontaneously hypertensive rats (SHR), lipo-AS013 also had a significant hypotensive effect. To confirm vascular wall targeting by lipo-AS013, the localization of PGE(1) in the aorta and neovascular capillaries of rat was investigated by immunostaining. The results indicated that lipo-AS013 was more efficient at delivering the active ingredient (AS013) to the vessel wall. In conclusion, lipo-AS013 could supersede lipo-PGE(1) and PGE(1)CD in clinical use.

Age differences in immunohistochemical localizations of large proteoglycan, PG-M/versican, and small proteoglycan, decorin, in the dermis of rats

Proteoglycans were localized immunohistochemically in the dermis of Donryu rats, using monoclonal antibodies raised against large proteoglycan (PG-M/versican) and small proteoglycan (decorin). The localizations of these proteoglycans in the dermis were compared between young rats (22-day old) and old ones (24 or 30 months of age), and distinct age differences were observed. In the young dermis, PG-M/versican was observed to be abundant in almost all fibroblastic cells (both cytoplasm and cell processes) whose cellularity was very rich compared with the dermis of old rats. Decorin was only faintly visible in the interstitial fibrous elements of young dermis. In the old dermis, however, decorin was distinctly detected on the fibrous elements, which were diffusely distributed as a fibrous network, and likewise PG-M/versican was visible in only a few fibrous elements which seemed to be the fine processes of fibroblastic cells. In the border layer between epidermis and dermis as well as the basal layer surrounding hair follicles, both large and small proteoglycans could be observed in old dermis. Since decorin, which was abundant in old dermis, has been found to have a growth inhibitory effect, it is conceivable that decorin may be one of the Cell Growth Inhibitory Factors in aging as proposed by Tauchi et al. [17, 18].

Genetic dissection of the yeast 26S proteasome: cell cycle defects caused by the Deltarpn9 mutation

Rpn9 is one of the subunits of the regulatory particle of the yeast 26S proteasome and is needed for stability or efficient assembly of the 26S proteasome. As anticipated from the fact that the rpn9 disruptant grew at 25 degrees C but arrested in G2/M phase at 37 degrees C, the CDK inhibitor Sic1p was found to be degraded at the G1/S boundary in the Deltarpn9 cells. The degradation of the anaphase inhibitor Pds1p was delayed in the Deltarpn9 cells. Clb2p in M phase, as well as that ectopically expressed in G1 and S phases, was degraded more slowly in the Deltarpn9 cells than in the wild type cells, indicating that the 26S proteasome lacking Rpn9 uses Sic1p as a better substrate than Pds1p and Clb2p. These results, in addition to the fact that multiubiquitinated proteins were accumulated in the Deltarpn9 cells incubated at 37 degrees C, strongly suggest that Rpn9 is involved in the proteolysis of a subset of the substrates degraded by the 26S proteasome. The Deltarpn9 Deltapds1 double mutant was unable to elongate spindle at a restrictive temperature, suggesting that some protein(s) other than Scc1 (cohesin) should be degraded during progression of anaphase.

Morphological diagnoses of the Japan Adult Leukemia Study Group acute myeloid leukemia protocols: Central review

A morphological review system of the Japan Adult Leukemia Study Group has developed from the AML-87 through the AML-92 experience. We reviewed 1427 (90%) of 1592 cases enrolled in the AML-87, -89, or -92 protocols for morphology; 1408 (88%) were eligible. The rate of diagnostic concordance between each institute and the Committee on Morphological Diagnosis ranged from 76% to 80%. Acute myeloid leukemia (AML) subtypes were as follows: AML M0, 27 (2%); M1, 179 (13%); M2, 472 (34%); M3, 358 (25%); M4, 265 (19%); M5, 57 (4%); M6, 39 (3%); and M7, 11 (1%). The reason for the high number of patients with AML M3 is that many M3 patients were enrolled in the AML-92 protocol, which contained all-trans-retinoic acid. AML M0, M6 and M7 belonged to the poor prognostic groups. Auer bodies were found in 284 (53%) of 538 patients who survived significantly longer than those without Auer bodies in AML-87/-89. In AML-92 except for AML M3, 259 (43%) of 602 cases were Auer+ and also showed better survival rates. The survival of patients with >50% myeloperoxidase (MPO)-positive blast cells was better than those with < or =50% MPO+ blast cells in AML-87/-89. This trend was also seen in AML-92 excluding M3. AML with trilineage dysplasia (AML/TLD) is characterized as a subtype of de novo AML that shows morphological dysplasia of mature hematopoietic cells on a background of leukemic blast cells The number of patients with AML/TLD was 89 (16.5%) of 545 patients reviewed in AML-87/-89. AML-92, except for M3, showed a higher rate of patients with TLD (161 cases; 27.6%) because there were no patients with TLD in the AML M3 group. Survival rates for AML/TLD were worse than those for AML/non-TLD in both the AML-87/-89 and -92 protocols. Eighty percent of all cases (793/986) entered in AML-92 were analyzed cytogenetically. Fifty-one cases were not available for karyotyping because of a lack of mitoses or inappropriate preparations. The most frequent karyotype was normal, which accounted for 34.2%. The t(15;17), t(8;21), and inv(16) karyotypes, which are regarded as good risk factors, were 23.8%, 9.2%, and 1.6%, respectively. Abnormal chromosomes 5, 7, t(9;22), and t(6;9) were considered to be poor or intermediate risk factors As a new system of karyotyping begins in the ongoing AML protocol, useful chromosomal data will be obtained in the near future.