Anti-PD-1 antibody monotherapy versus anti-PD-1 plus anti-CTLA-4 combination therapy as first-line immunotherapy in unresectable or metastatic mucosal melanoma: a retrospective, multicenter study of 329 Japanese cases (JMAC study)

Background

Anti-programmed cell death protein 1 (PD-1) antibody monotherapy (PD1) has led to favorable responses in advanced non-acral cutaneous melanoma among Caucasian populations; however, recent studies suggest that this therapy has limited efficacy in mucosal melanoma (MCM). Thus, advanced MCM patients are candidates for PD1 plus anti-cytotoxic T lymphocyte-associated antigen-4 (CTLA-4) combination therapy (PD1 + CTLA4). Data on the efficacy of immunotherapy in MCM, however, are limited. We aimed to compare the efficacies of PD1 and PD1 + CTLA4 in Japanese advanced MCM patients.

Patients and methods

We retrospectively assessed advanced MCM patients treated with PD1 or PD1 + CTLA4 at 24 Japanese institutions. Patient baseline characteristics, clinical responses (RECIST), progression-free survival (PFS), and overall survival (OS) were estimated using Kaplan–Meier analysis, and toxicity was assessed to estimate the efficacy and safety of PD1 and PD1 + CTLA4.

Results

Altogether, 329 patients with advanced MCM were included in this study. PD1 and PD1 + CTLA4 were used in 263 and 66 patients, respectively. Baseline characteristics were similar between both treatment groups, except for age (median age 71 versus 65 years; P < 0.001). No significant differences were observed between the PD1 and PD1 + CTLA4 groups with respect to objective response rate (26% versus 29%; P = 0.26) or PFS and OS (median PFS 5.9 months versus 6.8 months; P = 0.55, median OS 20.4 months versus 20.1 months; P = 0.55). Cox multivariate survival analysis revealed that PD1 + CTLA4 did not prolong PFS and OS (PFS: hazard ratio 0.83, 95% confidence interval 0.58-1.19, P = 0.30; OS: HR 0.89, 95% confidence interval 0.57-1.38, P = 0.59). The rate of ≥grade 3 immune-related adverse events was higher in the PD1 + CTLA4 group than in the PD1 group (53% versus 17%; P < 0.001).

Conclusions

First-line PD1 + CTLA4 demonstrated comparable clinical efficacy to PD1 in Japanese MCM patients, but with a higher rate of immune-related adverse events.

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Anti-PD-1 plus anti-CTLA-4 antibody therapy (PD1 + CTLA4) is an option for patients with advanced mucosal melanoma (MCM).

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Data on the efficacy of PD1 + CTLA4 compared with PD-1 monotherapy (PD1) for MCM, however, are limited.

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We retrospectively analyzed data from 329 Japanese patients with advanced MCM treated with PD1 or PD1 + CTLA4.

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No significant differences in objective response rate, progression-free survival, or overall survival were observed.

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Immune-related adverse events resulting in treatment cessation were higher in the PD1 + CTLA4 group.

Influence of lingual plate fracture pattern on remodelling site during the healing process of sagittal split ramus osteotomy

The purpose of this study was to investigate whether differences in the pattern of the lingual plate split in sagittal split ramus osteotomy (SSRO) affect the remodelling of the split site. Sixty-one patients with mandibular prognathism (122 sides) underwent SSRO. Computed tomography (CT) was performed at 1 week and 1 year after SSRO. Bone splits were classified according to the lingual split scale (LSS) and the lateral bone cut end (LBCE) by evaluating CT images at 1 week. The remodelling at the split sites was evaluated by superimposing the CT images obtained at 1 week and 1 year. Regarding the LSS pattern, significant differences were observed in the distance between anteroposterior ramus points (P = 0.033) and the ramus area in the axial image (P = 0.011). The LBCE pattern also showed a significant difference in the distance between anteroposterior ramus points (P = 0.043). In conclusion, the differences in the lingual plate split and ramus cut end of the SSRO influence the postoperative remodelling in the anteroposterior region of the split site.

Shift-and-add image processing incorporated with the unsharp masking method

Shift-and-add (SAA) is a simple image processing procedure. SAA was devised to reconstruct a diffraction-limited image from atmospherically degraded stellar images. Recently SAA has been applied to biological imaging. There are several variants of SAA. Here proposed is an SAA procedure incorporated with unsharp masking (USM). The SAA procedure proposed here encompasses an extended version of USM. The proposed SAA method retains the simplicity and easiness, and the basic features of SAA. The effectiveness of the proposed method is examined by restoring atmospherically degraded solar images. It is shown that the USM SAA reconstructed image exhibits high contrast and reveals fine structures blurred by atmospheric turbulence. It is also shown that the USM SAA performs better with a data frame selection scheme.

Difamilast ointment, a selective phosphodiesterase 4 inhibitor, in paediatric patients with atopic dermatitis: A phase 3 randomised double-blind, vehicle-controlled trial

Background

In atopic dermatitis (AD), phosphodiesterase 4 (PDE4) inhibition reduces proinflammatory mediators and cytokines. Difamilast is a new selective PDE4 inhibitor.

Objectives

To demonstrate the superiority of topical difamilast to vehicle in Japanese paediatric patients with AD.

Methods

This was a phase III randomized, double‐blind, vehicle‐controlled trial. Patients aged 2–14 years with an Investigator Global Assessment (IGA) score of 2 or 3 received difamilast 0·3% (n = 83), difamilast 1% (n = 85) or vehicle (n = 83) ointment twice daily for 4 weeks.

Results

The primary endpoint was the percentage of patients with an IGA score of 0 or 1 with improvement by at least two grades at week 4. The success rates in IGA score at week 4 were 44·6%, 47·1% and 18·1% in the difamilast 0·3%, difamilast 1% and vehicle groups, respectively. Both difamilast groups demonstrated significantly higher success rates in IGA score compared with vehicle at week 4 [difamilast 0·3% (P < 0·001); difamilast 1% (P < 0·001)]. Regarding secondary endpoints, improvements in Eczema Area and Severity Index (EASI; improvement of ≥ 50%, ≥ 75% and ≥ 90% in overall score) at week 4 were significantly higher in patients in the difamilast 0·3% and 1% groups than those in the vehicle group. EASI score in the difamilast 0·3% and 1% groups was significantly reduced compared with that of patients in the vehicle group at week 1. The significant difference between both the difamilast groups and the vehicle groups was maintained from week 1 through to week 4. Most treatment‐emergent adverse events were mild or moderate, and no serious events or deaths were reported.

Conclusions

Difamilast 0·3% and 1% ointments are superior to vehicle and well tolerated in Japanese paediatric patients with AD.

Basophils are recruited to inflamed lungs and exacerbate memory Th2 responses in mice and humans

BACKGROUND

Although the contribution of basophils as inducers or amplifiers of Th2 responses is still debated, prolonged basophil/CD4 T cell interactions were observed in lungs but not lymph nodes (LNs) of parasite-infected mice. However, the impact of basophils on the function of tissue CD4 effector T cells remains unknown.

METHODS

Basophils were purified from the lungs of ovalbumin (OVA)-sensitized and OVA-challenged (OVA-immunized) mice or human peripheral blood for in vivo and in vitro functional studies. Pulmonary basophils were adoptively transferred to OVA-sensitized hosts to assess airway inflammation in bronchoalveolar lavage fluid (BALF) and Th2 responses in lung explants and draining LNs. Basophils were co-cultured with effector T cells or Ag-specific naïve T cells alone or in combination with dendritic cells (DCs); IL-4 production was determined by flow cytometry and ELISA.

RESULTS

Basophils accumulated in lungs of OVA-immunized mice. Adoptive transfer of basophils to OVA-sensitized hosts enhanced lung IL-4 and IL-13 release while co-administration of OVA further aggravated airway inflammation and Th2 responses in LNs. Mechanistic in vitro studies revealed that pulmonary basophils interacted with lung CD4 effectors, in the absence of DCs, to increase T cell survival and Th2 cytokine expression at the single cell level but amplified OVA-loaded DC-driven Th2 differentiation. Finally, human basophils augmented in vitro IL-4 expression in effector memory CD4 T cells that include CRTH2(+) cells through IL-4 and TCR-independent pathways.

CONCLUSIONS

Basophils may worsen Th2 inflammatory disorders through direct interactions with pathogenic CD4 T cells as well as by enhancing DC-induced Th2 cell development.

Structure-activity relationship of antioxidants for inhibitors of linoleic acid hydroperoxide-induced toxicity in cultured human umbilical vein endothelial cells

Structure-activity relationship of antioxidants for the protective effects on linoleic acid hydroperoxide (LOOH)-induced toxicity were examined in cultured human umbilical vein endothelial cells. alpha-Tocopherol, 2,2,5,7,8-pentamethylchroman-6-ol, butylated hydroxytoluene, probucol, and fatty acid esters of ascorbic acid provided efficient protection against the cytotoxicity of LOOH in pretreatment, but phenols without alkyl groups at the ortho positions and hydrophilic antioxidants such as Trolox and ascorbic acid provided no protection. Probably, the effectiveness of the protection against cytotoxicity by these antioxidants dependsprimarily on their rate of incorporation into cells due to their lipophilicity, secondly on their antioxidant activity, and thirdly on their orientation in biomembranes. On the other hand, flavones, such as baicalein and luteolin bearing 3 to 5 hydroxyl groups, and flavonols showed a protective effect against LOOH cytotoxicity when added together with LOOH,but not by pretreatment. Among catechins, (+)-catechin and (-)-epigallocatechin gallate monoglucoside and diglucoside were effective in suppressing LOOH-induced cytotoxicity, but their effects were not so strong. The structure-activity relationship of flavonoids revealed the presence of either theortho-dihydroxy structure in the B ring of flavonoids or the 3-hydroxyl and 4-oxo groups in the C ring to be important forthe protective activities. Furthermore, coumarins such as esculetin containing the ortho catechol structure had protective effects in both pretreatment and concurrent treatment. These results suggest that ortho catechol moiety of flavonoids, catechins, and coumarins is an important structure in the protection against LOOH-induced cytotoxicity,and that the alkyl groups of monophenols are critical for protection.

Study of Pd-Ag dental alloys: examination of effect of casting porosity on fatigue behavior and microstructural analysis

The goals of this study were to investigate the fatigue limits of two Pd-Ag alloys (Ivoclar Vivadent) with differing mechanical properties and varying proportions of secondary alloying elements, examine the effect of casting porosity on fatigue behavior, and determine the effect of casting size on microstructures and Vickers hardness. The alloys selected were: IPS d.SIGN 59 (59.2Pd-27.9Ag-8.2Sn-2.7In-1.3Zn); and IS 64 (59.9Pd-26.0Ag-7.0Sn-2.8Au-1.8 Ga-1.5In-1.0Pt). Tension test bars, heat-treated to simulate dental porcelain application, were subjected to cyclic loading at 10 Hz, with R-ratio of -1 for amplitudes of compressive and tensile stress. Two replicate specimens were tested at each stress amplitude. Fracture surfaces were examined with a scanning electron microscope (SEM). Sectioned fatigue specimens and additional cast specimens simulating copings for a maxillary central incisor restoration were also examined with the SEM, and Vickers hardness was measured using 1 kg load. Casting porosity was evaluated in sectioned fatigue fracture specimens, using an image analysis program. The fatigue limit (2 × 10(6) loading cycles) of IS 64 was approximately 0.20 of its 0.2% yield strength, while the fatigue limit of d.SIGN 59 was approximately 0.25 of its 0.2% yield strength. These relatively low ratios of fatigue limit to 0.2% yield strength are similar to those found previously for high-palladium dental alloys, and are attributed to their complex microstructures and casting porosity. Complex fatigue fracture surfaces with striations were observed for both alloys. Substantial further decrease in the number of cycles for fatigue failure only occurred when the pore size and volume percentage became excessive. While the heat-treated alloys had equiaxed grains with precipitates, the microstructural homogenization resulting from simulated porcelain firing differed considerably for the coping and fatigue test specimens; the latter specimens had significantly higher values of Vickers hardness.

Furuncular myiasis: unusual case of African Dermatobia hominis

Human cutaneous myiasis is a common disease in endemic tropical zones. Increased international travel has produced increases in imported cases. We present an unusual patient with myiasis infestation of the leg caused by Dermatobia hominis, which manifested after returning from the Democratic Republic of Congo. This particular infestation has not been reported in Morocco prior to this case. Furuncular cutaneous miyasis must be considered when travellers exhibit draining nodules. Medical treatment consists of occlusion of the furuncular punctum with vaseline to stimulate extrusion of the larva or surgical debridement under local anesthesia.

Immature platelet fraction measurement in patients with chronic liver disease: a convenient marker for evaluating cirrhotic change

Platelet number is often used as an indicator of the severity of liver disease. Although inadequate thrombopoietin production and decreased platelet production have been proposed as major causes of cirrhotic thrombocytopenia, the underlying mechanism has not yet been fully clarified. We examined whether the measurement of the immature platelet fraction (IPF) in thrombocytopenic patients with liver dysfunction is useful as a rapid and noninvasive method for the differential diagnosis of chronic liver diseases. We examined 20 liver cirrhosis patients, 56 patients with chronic hepatitis, 9 patients with fatty liver, and 86 patients without liver disease. The percentage value of IPF (IPF%) was measured using an XE-2100 multiparameter automatic hematology analyzer. Using a receiver operating characteristic curve, we found diagnostic significance of the absolute platelet count and the absolute number of the IPF between cirrhotic patients and noncirrhotic patients, and developed a powerful multivariate discriminant analysis (MDA) function based on the platelet count and the IPF%. The diagnostic accuracy obtained by the MDA function was superior to that obtained by the absolute number of platelets and the IPF. We therefore propose our IPF% measurement for the diagnosis of liver cirrhosis.

Method to reconstruct exoplanetary spectrum

We present a method for spectroscopic observations of exoplanets. Coronagraphic image of a star-planet system and its objective spectra are observed simultaneously. Stellar image and objective spectrum without coronagraphic suppression are also obtained as reference. By convolution of the coronagraphic image with the reference stellar spectrum, pseudo-objective spectra are synthesized. The difference between the observed and the synthesized pseudospectra reveals the distinctive features of planetary spectrum. We carry out laboratory demonstration of the proposed technique and show that the planetary spectrum is reconstructed.

A case of Evans syndrome combined with systemic lupus erythematosus successfully treated with rituximab

Evans syndrome is a rare autoimmune disorder with unknown aetiology. Although corticosteroids and/or intravenous immunoglobulin (IVIG) are commonly used in its treatment, no standard strategy has been established. We report here a 44-year-old male with refractory Evans syndrome combined with systemic lupus erythematosus (SLE) who responded well to rituximab. He was admitted to our hospital with severe bleeding caused by worsening of Evans syndrome. Despite treatment with a high-dose corticosteroid and IVIG, his thrombocytopaenia and haemolytic anaemia did not improve. We started rituximab at a dose of 375 mg/m(2) once a week for a total of two doses. There was significant improvement in his thrombocytopaenia and anaemia 1 month after administration of rituximab. Although the total immunoglobulin G (IgG) level did not change, the titres of platelet-associated IgG (PA-IgG) and of an indirect antiglobulin test (IAT) decreased under the treatment with rituximab. It is suggested that rituximab would be a powerful candidate in the treatment of refractory Evans syndrome by depleting abnormal clone-producing autoantibody.

A new learning algorithm for the hierarchical structure learning automata operating in the nonstationary S-model random environment

An extended algorithm of the relative reward strength algorithm is proposed. It is shown that the proposed algorithm ensures the convergence with probability I to the optimal path under the certain type of nonstationary environment. Several computer simulation results confirm the effectiveness of the proposed algorithm.

Polarization degree analysis of objective spectrum in polarization differential stellar coronagraph

It is shown that the degree of polarization analysis is useful to find objective spectra of exoplanets immersed in noisy stellar spectra. We report the laboratory experiment of polarization differential objective spectroscopy with a four-quadrant polarization mask coronagraph, where partially polarized planetary signal is expected to be discerned from unpolarized stellar noise. The detection of the planet signal is impeded by the stellar noise remained after subtracting mutually orthogonally polarized components of light. We distinguish clearly the planetary spectrum by use of the degree of polarization. We also show the refinement of the spectrum of the planet model.

[Cutaneous blastomycosis revealing intravascular B-cell lymphoma: a case in Morocco]

Blastomycosis is a systemic fungal infection caused by a thermally dimorphic fungus, Blastomyces dermatitidis. The incidence in immunocompromised patients has increased in the last two decades. A 55-year-old man consulted for inflammatory nodules on the forearm. Biopsy of one nodules showed a pseudoepitheliomatous hyperplastic epidermis overlaying a dense agranulomatous inflammatory infiltrate containing free-formed ovoid bodies enclosing giant macrophageous cells. These findings were consistent with blastomycosis. After a month of treatment cutaneous lesions regressed partially but the patient's general status continued to deteriorate with the appearance of an edematous-ascitic syndrome and icterus. Laboratory blood testing demonstrated cholestasia and abdominal ultrasound showed hepatosplenomegaly. Needle liver biopsy revealed giant B-cell lymphomatous infiltration of the hepatic ducts. The patient's condition worsened rapidly and he died five months after diagnosis despite four rounds of chemotherapy. Blastomycosis is rare in Morocco. Primary infection is usually a pneumonic process. Isolated cutaneous infection is possible but uncommon. To our knowledge the association of blastomycosis and intravascular lymphoma has not been previously reported. In immunocompromised patients, clinical findings can be alarming and the outcome can be rapidly fatal.

Nd:YAG laser penetration into cast titanium and gold alloy with different surface preparations

This study investigated the effect of surface preparation on the Nd:YAG laser penetration into cast titanium and gold alloy. Cast blocks of each metal were given four different surface preparations: (i) coloured with black marker; (ii) air-abraded with 50 microm Al2O3; (iii) ground with SiC points and (iv) polished with 1 microm Al2O3 (mirror-polished). Two blocks with each of the surface preparations were abutted and laser-welded at their interface using the voltages of 210-260 V in increments of 10 V. After the welded blocks were mechanically separated, the laser penetration was measured using computer graphics. Regardless of the surface preparation, an increase in voltage increased the laser penetration for both metals. The laser penetration into titanium prepared with black marker and air-abrasion was significantly deeper than into the titanium ground with SiC points and mirror-polished. Although there were no statistical differences in penetration among the surface preparations for the gold alloy, the penetration in the mirror-polished specimens was shallower than any of the other preparation methods at higher voltages of 240-260 V. The results obtained in this study suggested that broken metal frameworks with finished surfaces should be painted with black marker or air-abraded before laser welding.

Penetration depth into dental casting alloys by Nd:YAG laser

This study investigated the effect of laser-beam welding conditions [voltage (V) and spot diameter (mm)] on the penetration depth into dental casting alloys. Castings (3.0 mm x 8.0 mm x 50 mm) were prepared from the metals used in this study: commercially pure titanium (CP Ti), Ti-6Al-4V, Ti-6Al-7Nb, cobalt-chromium alloy (Co-Cr) and Type IV gold alloy. Two cast blocks of each metal were butted against one another at the 8.0 x 50-mm surfaces. They were then welded at their interface under the following conditions: voltage of 160-340 V, spot diameter of 0.4-1.6 mm, and pulse duration of 10 ms. After laser welding, the blocks were separated, and the penetration depth into each alloy was measured. The data were analyzed with the use of ANOVA at the p < 0.05 level of significance. The penetration depths were as follows: CP Ti (0.29-6.45 mm), Ti-6Al-4V (0.32-5.24 mm), Ti-6Al-7Nb (0.34-5.65 mm), Co-Cr (0.24-6.15 mm), and Type IV gold alloy (0.12-5.22 mm). The voltage and spot diameter affected the penetration depth into the metals tested. When the voltage increased and the spot diameter decreased, the penetration depth increased for each metal. Selecting suitable conditions for laser welding to obtain sufficient penetration depth for the optimal thickness of the metal is important when welding prostheses.

Mechanical strength of laser-welded cobalt-chromium alloy

The purpose of this study was to investigate the effect of the output energy of laser welding and welding methods on the joint strength of cobalt-chromium (Co-Cr) alloy. Two types of cast Co-Cr plates were prepared, and transverse sections were made at the center of the plate. The cut surfaces were butted against one another, and the joints welded with a laser-welding machine at several levels of output energy with the use of two methods. The fracture force required to break specimens was determined by means of tensile testing. For the 0.5-mm-thick specimens, the force required to break the 0.5-mm laser-welded specimens at currents of 270 and 300 A was not statistically different (p > 0.05) from the results for the nonwelded control specimens. The force required to break the 1.0-mm specimens double-welded at a current of 270 A was the highest value among the 1.0-mm laser-welded specimens. The results suggested that laser welding under the appropriate conditions improved the joint strength of cobalt- chromium alloy.

Detoxification mechanism of heavy metals in marine mammals and seabirds: interaction of selenium with mercury, silver, copper, zinc, and cadmium in liver

Subcellular distribution of mercury, selenium, silver, copper, zinc, and cadmium was determined in the liver of northern fur seals (Callorhinus ursinus), black-footed albatrosses (Diomedea nigripes), and Dall's porpoises (Phocoenoides dalli). Mercury, selenium, and silver were preferentially accumulated in nuclear, lysosomal, and mitochondrial fraction with an increase in their hepatic concentrations, whereas copper, zinc, and cadmium were accumulated mainly in cytosol with an increase in the hepatic concentrations for all three species. To gain insight into the existing state of the metals, they were extracted with four extractants--sodium dodecylsulfate (SDS); 2-mercaptoethanol; 2-mercaptoethanol + guanidinium thiocyanate; and copper sulfate (CuSO4)--at several concentrations from nuclear, lysosomal, and mitochondrial fraction in liver from a specimen of northern fur seal. Extraction efficiencies of the metals for 2-mercaptoethanol + guanidinium thiocyanate and CuSO4 were much higher than those for SDS and 2-mercaptoethanol. Also, for all individuals of the three species, metals were extracted by the three extractants--2% SDS; 0.25 mol/L 2-mercaptoethanol + 5 mol/L guanidinium thiocyanate; and 0.1 mol/L CuSO4--from nuclear, lysosomal, and mitochondrial fraction of liver. In the northern fur seals with higher concentration of mercury, the molar ratio of selenium to mercury approached unity in the nonextractable fraction of 0.25 mol/L 2-mercaptoethanol + 5 mol/L guanidinium thiocyanate, suggesting the possible formation of mercuric selenide (HgSe) with increasing hepatic concentration. Because the nonextractable content of mercury and its distribution were larger for black-footed albatross than those for the other two species, it was suggested that the black-footed albatross has a stronger ability to form a stable compound(s) of mercury in the liver. It is notable that the existing state of silver was similar to that of mercury as judged by their subcellular distribution and the extraction tests, suggesting that silver also interacted with selenium in the liver of marine animals used in this study.

Isolation of Legionella pneumophila from hospital cooling towers in Johor, Malaysia

Water-based cooling towers and their water supply at two hospitals in Johor were surveyed for the presence Legionella pneumophila. L. pneumophila were grown from 19 (76%) out of 25 collected water samples. One hospital cooling tower was contaminated with L. pneumophila serogroup 1.

Effect of heat treatments on machinability of gold alloy with age-hardenability at intraoral temperature

OBJECTIVE

This study investigated the effect of heat treatment on the machinability of heat-treated cast gold alloy with age-hardenability at intraoral temperature using a handpiece engine with SiC wheels and an air-turbine handpiece with carbide burs and diamond points.

METHODS

Cast gold alloy specimens underwent various heat treatments [As-cast (AC); Solution treatment (ST); High-temperature aging (HA), Intraoral aging (IA)] before machinability testing. The machinability test was conducted at a constant machining force of 0.784N. The three circumferential speeds used for the handpiece engine were 500, 1,000 and 1,500 m/min. The machinability index (M-index) was determined as the amount of metal removed by machining (volume loss, mm(3)). The results were analyzed by ANOVA and Scheffé's test.

RESULTS

When an air-turbine handpiece was used, there was no difference in the M-index of the gold alloy among the heat treatments. The air-turbine carbide burs showed significantly (p<0.05) higher M-indexes than the diamond points after any heat treatments. With the SiC wheels, increasing the circumferential speed increased the M-index values for each heat treatment. The specimens heat-treated with AC, HA and IA had similar M-indexes at the lower speeds (500 and 1,000 m/min). The ST specimens exhibited the lowest M-index at the lower speeds. However, at the highest speed (1,500 m/min), there were no significant differences in the M-indexes among the heat treatments except for HA, which showed the highest M-index.

CONCLUSION

There was no effect of heat treatment on the machinability of the gold alloy using the air-turbine handpiece. The heat treatments had a small effect on the M-index of the gold alloy machined with a SiC wheel for a handpiece engine.

Surface treatment of dentin with GLUMA and iron compounds for bonding indirect restorations

The purpose of this study was to evaluate five dentin bonding systems simulating indirect restorations. The surface of bovine and human dentin was primed with a glutaraldehyde agent (GLUMA) and placed in a humidor at 37 degrees C for 168 h. In an experimental bonding system (GLUMA/CY/SB), the surfaces were etched with phosphoric acid, primed with cytochrome c, and then bonded to an acrylic rod with a self-curing resin (4-META/MMA-TBB). Specimens using two commercially available bonding systems [All-Bond 2 (AB2) and Super-Bond C & B (10-3/SB)] and two controls with and without GLUMA (GLUMA/10-3/SB and CY/SB) were also prepared. Tensile testing revealed that the bond strengths were influenced by the bonding system, 168 h dentin exposure and their interaction, but not by the tooth origin. AB2 showed the lowest bond strength. With the 10-3/SB system, exposing the dentin to humidity resulted in a decrease in bond strength. After 168 h of exposure, no significant differences were observed between 10-3/SB and CY/SB. The most effective bonding was obtained with the bonding systems of GLUMA/10-3/SB and GLUMA/CY/SB. Improved outcome is expected with these bonding systems when building up abutment teeth with indirect restorations.

Effect of disinfectants containing glutaraldehyde on bonding of a tri-n-butylborane initiated resin to dentine

The purpose of this study was to evaluate the effects of disinfectants on the bond strength of resin to dentine. The surface of bovine dentine was exposed to formaldehyde (FA) aqueous solutions, glutaraldehyde (GA) aqueous solutions, 2-hydroxyethyl methacrylate aqueous solutions (HEMA), a commercially available dentine primer (Gluma CPS desensitizer, GLUMA), isotonic sodium chloride solution (IS), and distilled water (DW), and placed in a humidor (HU) at 37 degrees C, or non-stored (baseline). All dentine surfaces were conditioned with a 10% citric acid and 3% ferric chloride solution (10-3 liquid), and then bonded to an acrylic rod with a self-curing adhesive resin (Super-Bond C&B). The mean tensile bond strengths determined 24 h after bonding were compared by analysis of variance (ANOVA) and Fisher's protected LSD test (n=5, P < or = 0.05). The exposure of dentine to IS, DW and HU for both 48 and 168 h resulted in a decrease in bond strength when compared with the baseline. The highest bond strengths after 168 h of exposure were obtained with 5% GA, 10% HEMA, and GLUMA, the values of which were equivalent to baseline and were significantly higher than that of FA. It is concluded that disinfectant pre-treatment with 5% GA or GLUMA stabilizes the bonding of tri-n-butylborane (TBB) initiated luting agent to bovine dentine conditioned with 10-3 liquid.

[Kwashiorkor after an exclusion diet for eczema]

BACKGROUND

Nutritional disorders observed in children with eczema may be aggravated by inappropriate diet, sometimes with dramatic effects.

CASE REPORT

A child aged 3 years 7 months presented a state of severe malnutrition with edema (kwashiorkor). The child had chronic eczema and had been given a highly restrictive diet based on a principle of exclusion without medical advise. Cure was achieved without sequelae with a normal diet.

DISCUSSION

This case illustrates the fragility of nutritional status in children with chronic widespread skin disease due to the risk of cutaneous loss of protein. Kwashiorkor is an exceptional observation in developed countries and, in this context, might be on the rise due to the popularity of exclusion diets for presumed allergic disease.

Nulling interferometry by use of geometric phase

Nulling interferometry is a method of detecting a faint source near a bright one, in which destructive interference is realized for the light from the bright source. A nulling interferometer that makes use of geometric phase (Pancharatnam phase) is proposed. An experimental setup is constructed to simulate a stellar interferometer with geometric-phase modulation. We attained extinction of 6 x 10(-5) in white light.

An auto-tuning method for focusing and astigmatism correction in HAADF-STEM, based on the image contrast transfer function

An auto-tuning method for high-angle annular detector dark field scanning transmission electron microscopy (HAADF-STEM) is proposed which corrects the defocus to the optimum Scherzer focus and compensates the astigmatism. Because the method is based on the image contrast transfer function formulated for the HAADF-STEM, the defocus and the astigmatism are accurately measured from input of two different defocus images. The method is designed to work independent of object function in the linear imaging model by analysing the spectral ratio between two Fourier spectra of their images, which is useful for cases where the spectrum of object function is not uniformly spread out over the reciprocal space. The method was preliminarily tested in a Hitachi HD-2000 STEM, and successful results of the auto-tunings from the viewpoint of verification of the algorithm were obtained using general specimens of Au fine particles and a thin section of a semiconductor device.

Effects of tomato juice consumption on plasma and lipoprotein carotenoid concentrations and the susceptibility of low density lipoprotein to oxidative modification

Effects of tomato juice supplementation on the carotenoid concentration in lipoprotein fractions and the oxidative susceptibility of LDL were investigated in 31 healthy Japanese female students. These subjects were randomized to one of three treatment groups; Control, Low and High. The Control, Low and High groups consumed 480 g of a control drink, 160 g of tomato juice plus 320 g of the control drink, and 480 g of tomato juice, providing 0, 15 and 45 mg of lycopene, respectively, for one menstrual cycle. The ingestion of tomato juice, rich in lycopene but having little beta-carotene, increased both lycopene and beta-carotene. Sixty-nine percent of lycopene in plasma was distributed in the LDL fraction and 24% in the HDL fraction. In the Low group, the lycopene concentration increased 160% each in the VLDL+IDL, LDL and HDL fractions (p<0.01). In the High group, the lycopene concentration increased 270% each in the VLDL+IDL and LDL fractions, and 330% in the HDL fraction (p<0.01). Beta-carotene also increased 120% and 180% in LDL fractions of the Low and the High groups, respectively. Despite these carotenoid increases in LDL, the lag time before oxidation was not prolonged as compared with that of the Control group. The propagation rate decreased significantly after consumption in the High group. Multiple regression analysis showed a positive correlation between lag time changes and changes in the alpha-tocopherol concentration per triglyceride in LDL, and a negative correlation between propagation rate changes and changes in the lycopene concentration per phospholipid in LDL. These data suggest that alpha-tocopherol is a major determinant in protecting LDL from oxidation, while lycopene from tomato juice supplementaion may contribute to protect phospholipid in LDI, from oxidation. Thus, oral intake of lycopene might be beneficial for ameliorating atherosclerosis.

Cytotoxicity of reactive oxygen species and related agents toward undifferentiated and differentiated rat phenochromocytoma PC12 cells

The cytotoxicity of reactive oxygen species and related agents toward cultured rat adrenal medullary phenochromocytoma PC12 cells was examined. These species and agents include hydrogen peroxide, linoleic acid hydroperoxide (LOOH), tert-butyl hydroperoxide, paraquat, 2,2'-azobis(2-amidinopropane) dihydrochloride (AAPH), 2,2'-azobis(2,4-dimethylvaleronitrile) (AMVN), and a hypoxanthine-xanthine oxidase system. The respective 50% lethal concentrations (LC50) for undifferentiated and differentiated PC12 cells were found to be 275 and 165 microM of hydrogen peroxide, 58.3 and 35.3 microM of LOOH, 536 and 212 microM of tert-butyl hydroperoxide, 42.5 and 26.5 mM of paraquat, 79.5 and 74.5 mM of AAPH, 412 and 300 microM of AMVN, and 37.2 and 16.6mU x ml(-1) xanthine oxidase activity of the hypoxanthine-xanthine oxidase system. These results show that the differentiated cells were more susceptible to these oxidative agents than the undifferentiated cells. The glutathione peroxidase activity level of the undifferentiated cells was 2-3 times higher than the differentiated cells, the catalase activity level also tended to be higher, the superoxide dismutase activity level was higher on a per-protein-quantity basis but lower on a per-cell-number basis, and the total and reduced glutathione concentration levels were considerably higher. The enhanced susceptibility of the differentiated cells may result from decreases in the activity of glutathione peroxidase and the concentration of its substrate, reduced glutathione (GSH). Further, the preincubation of PC12 cells with alpha-tocopherol or L-buthionine-(R,S)-sulfoximine (BSO) lowered or enhanced their cytotoxicities, respectively.

[Cutaneous blastomycosis revealing a corticoadenoma]

BACKGROUND

Blastomycosis is an uncommon chronic granulomatosis caused by Blastomyces dermatitidis. We present a case with a skin localization that disclosed malignant corticoadenoma.

CASE REPORT

A 32-year-old man consulted for inflammatory nodules of the face and lower limbs. The histological examination of a nodule biopsy was in favour of blastomycosis. Ketoconazole treatment was ineffective. Amphotericin B provided cure of the skin lesions. Search for extension disclosed a malignant corticoadrenoma.

DISCUSSION

Blastomycosis is very rare in Morocco. The portal is usually the lung. Unique skin involvement is very exceptional. To our knowledge this is the first report of a blastomycosis-corticoadenoma association. The clinical situation may be alarming in immunodepressed subjects. Amphotericin B treatment is indicated.

Measurement of telescope aberrations through atmospheric turbulence by use of phase diversity

We conduct computer simulations of the reconstruction of a wave front at a telescope pupil with the phase-diversity method. An instantaneous wave front is reconstructed from focused and defocused specklegrams of a point star. In the wave-front reconstruction we do not fit the wave front to Zernike polynomials but retrieve the phase with a phase-unwrapping procedure. Averaging over many atmospherically perturbed wave fronts leads to the residual phase error, namely, the aberration of the telescope. The scintillation effect, nonuniformity of amplitude on a telescope pupil, is also discussed.

Accumulation of silver in the liver of three species of pinnipeds

Silver in the three species of pinnipeds [northern fur seal (Callorhinus ursinus), Steller sea lion (Eumetopias jubatus), and harbor seal (Phoca vitulina)] caught in the North Pacific Ocean were analyzed using inductively coupled plasma-mass spectrometry, in order to understand accumulation and distribution of silver in pinnipeds. In northern fur seals, relatively high concentrations of silver were observed in the liver and body hair. Some 70% of the silver burden was concentrated in the liver. Hepatic silver concentrations were significantly correlated to age in northern fur seals (r = 0.766, P < 0.001, n = 49) and Steller sea lions (r = 0.496, P < 0.01, n = 28). Levels of silver concentrations per wet weight (microgram g-1) in the three pinnipeds ranged from 0.04 to 0.55 for northern fur seals, from 0.1 to 1.04 for Steller sea lions and from 0.03 to 0.83 for harbor seals. Silver concentrations in liver for all pinnipeds were significantly correlated with mercury, and selenium (P < 0.001). Molar ratios between silver to selenium approximated 1:180 in northern fur seals, 1:120 in Steller sea lions, and 1:60 in harbor seals. The silver-mercury molar ratios were approximately 1:170 in northern fur seals, and 1:80 both in the other species. Increase in silver accumulation in the liver was caused by the retention in nuclei and mitochondria fraction together with mercury and selenium in the cells of northern fur seals.

Synthesis of a novel lysophosphatidylcholine

The novel lysophosphatidylcholine (1), which naturally occurs in the marine sponge Spirastrella abata and was reported to inhibit cholesterol biosynthesis in the Chang liver cell, has been synthesized in four steps from methyl cis-11-octadecenoate (2).

Molecular cloning of the gene encoding an outer-membrane-associated beta-N-acetylglucosaminidase involved in chitin degradation system of Alteromonas sp. strain O-7

The gene encoding beta-N-acetylglucosaminidase (GlcNAcaseA) was cloned using PCR with degenerate oligonucleotide primers from the partial amino acid sequence of the enzyme. The gene encoded a polypeptide of 863 amino acids with a predicted molecular mass of 97kDa. A characteristic signal peptide, which was present at the amino-terminus of the precursor protein, contained four amino acids (Ala-Gly-Cys-Ser) identical in sequence and location to the processing and modification sites of the outer membrane lipoprotein of Escherichia coli, indicating that the mature GlcNAcaseA is a lipoprotein the N-terminal cysteine residue of which would be modified by the fatty acid that anchors the protein in the membrane. The predicted amino acid sequence of GlcNAcaseA showed similarity to bacterial beta-N-acetylglucosaminidases belonging to the family 20 glycosyl hydrolases.

Prevention of death of axotomized hypoglossal neurones and promotion of regeneration by chitin grafting

1. Chitin is known to promote skin wound healing. In this study, chitin, prepared from Zuwai crab shell, was used as a bridge between the proximal and distal stumps of cut hypoglossal nerves in shrews. We compared the effects of chitin on the regeneration of transected right hypoglossal nerve axons, with those of porcine dermis, bovine dermal aterocollagen, and autologous nerve bundles. 2. To assess the survival of neurones, the size of neuronal cell body, and number of motoneurones were determined in the absence of any bridged material and in the presence of porcine dermis, bovine dermal aterocollagen, chitin, or autologous nerve bundles as a bridge. 3. Our results revealed a significantly better outcome in chitin and autologous nerve bridged groups; the size of neuronal cell body and number of hypoglossal neurones were higher than in the other groups. Chitin also enhanced the regeneration of neurones; the number of horseradish peroxide positive neurones indicative of repaired axonal processes was significantly higher in chitin and autologous nerve-bridged groups than in other groups. 4. Our results demonstrated that the use of chitin sheet or autograft successfully prevented the death of severed neurones and promoted the regeneration of the lesioned nerve. Although the mechanisms underlying the effects of chitin are still unknown, chitin seems to be a potentially useful biocompatible material for nerve repair and regeneration.

Enhancement of rat hypoglossal nerve regeneration by chitin sheet plus gangliosides

The effects of chitin sheet interposition with and without brain gangliosides on the regeneration of hypoglossal nerve fibres was studied in the rat following resection of a 5mm length of the nerve. At 10 weeks after operation, the number of horseradish peroxidase (HRP)-labelled motor neurones, indicative of the axonal repair process, on the side treated with chitin and gangliosides was higher than on the control side (where 5mm of the nerve was simply resected). The ratios of HRP-positive neurones in the right hypoglossal nucleus (treated side)/left hypoglossal nucleus (intact side) was 0 in the 5mm-resected group, 53% in the chitin-grafted group, 88% in the ganglioside (0.2 microg)-injected group, 90% in the ganglioside (2 microg)-injected group, 91% in the chitin with ganglioside (0.2mg)-injected group, 91% in the chitin with ganglioside (2 microg)-injected group and 85% in the autograft group, respectively. There were significant differences between the 5 mm-resected group and chitin-grafted group, ganglioside-injected group, chitin with ganglioside group and autograft group, and between the chitin-grafted group and ganglioside-injected, chitin with ganglioside and autograft groups (P< 0.005, respectively). Our results indicated that the use of chitin and gangliosides stimulated the regeneration of severed motor nerve fibres. These findings suggest that chitin and gangliosides might be therapeutically useful for treatment of neuronal degeneration.