Clinical implications of the BRAF mutation in papillary thyroid carcinoma and chronic lymphocytic thyroiditis

Background

The purpose of this study was to examine the possible prognostics and clinicopathologic characteristics underlying the BRAFV600E mutation and papillary thyroid carcinoma (PTC) coexisting or in absence of chronic lymphocytic thyroiditis (CLT).

Methods

This study was conducted on 172 patients who had undergone total thyroidectomy or unilateral total thyroidectomy for PTC; the patients were then examined for the BRAFV600E mutation using specimens obtained after their surgery from January 2013 to August 2015.

Results

BRAF mutations were found in 130 of 172 patients (75.6%). CLT was present in 27.9% of patients (48/172). The incidence of the BRAFV600E mutation was significantly increased in the group with no CLT (P = 0.001). The findings of the multivariate analysis pertaining to the coexistence of CLT and PTC showed no significant correlation other than the BRAFV600E mutation. No significant difference was noted in the clinicopathologic factors between the two groups based on the coexistence of CLT in univariate and multivariate analyses.

Conclusions

The BRAFV600E mutation is less frequent in PTC coexisting with CLT presumably because CLT and the BRAFV600E mutation operate independently in the formation and progression of thyroid cancer.

Incidentally detected breast lesions on chest CT with US correlation: a pictorial essay

With the increasing use of computed tomography (CT), incidental breast lesions are detected more frequently. When interpreting chest CT findings, it is important for radiologists to carefully review the breast to recognize any abnormal findings that could affect patient management. The purpose of this study is to discuss incidental breast lesions on chest CT with ultrasonography correlation that may be encountered in routine clinical practice.

Abstract P4-09-21: Dual expression of aquaporin 3 and 5 in patients with early breast cancer

Background: We reported separately that AQP5 or AQP3 expression in tumor tissue may predict survival after surgery for the specific types of early breast cancer (EBC). However, there is no definitive evidence for the role of dual expression of the two AQPs. Therefore, the current study focused the association and its prognostic impact of their tumoral expressions in the same patients.

Patients and Methods: AQP3 and AQP5 expressions were investigated on the basis of the immunohistochemistry of tissue microarray specimens from 447 EBC patients who underwent surgery between 2003 and 2008 as described in previous studies. Patients were divided into 4 subgroups based on AQP3 and AQP5 expressions: group1 for (-/-), group2 for (-/+), group 3 for (+/-), and group 4 for (+/+), respectively.

Results: Among 477 patients, the number of patients for each group was as follows: group 1 (n=193, 43.2%), group 2 (n=74, 16.6%), group3 (n=110, 24.6%) and group 4 (n=70, 15.7%), respectively. In the current study a positive correlation was identified between AQP3 and 5 expressions (P=0.017 by a χ2- test) in particular for HER2- overexpressing and ER-positive tumors (P=0.009 and 0.044, respectively). Multivariate survival analysis showed that dual expression of AQP3 and AQP5 was a negative prognostic factor for relapse-free or distant disease-free survival for patients with HER2-overexpressing EBC (HR=3.107 and 3.683; P=0.043 and 0.027, respectively), statistically more prominent compared in case with AQP3 expression alone (HR=3.137 and 2.784; P=0.036 and 0.070, respectively).

Conclusion: Dual expression of AQP3 and AQP5 in tumor tissue may be considered as a potential prognostic marker in patients with HER2-overexpressing EBC after curative surgery.

Citation Format: Lee SJ, Chae YS, Kwon TJ, Chung JH, Lee J, Jung JH, Kim WW, Park HY, Jeong JY, Park S-H, Park S. Dual expression of aquaporin 3 and 5 in patients with early breast cancer. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P4-09-21.

Is It Contralateral Axillary Metastasis or Occult Breast Cancer?: A Confusing Case Report

We report the case of a 43-year-old woman with primary left breast cancer presenting metastatic lymphadenopathy in the contralateral axilla. This patient represents a diagnostic and therapeutic challenge because primary breast cancer, occult contralateral breast cancer, and extra-mammary primary lesion can all be the source of the contralateral axillary metastasis. Left breast-conserving surgery, left sentinel lymph node biopsy, right breast mass excision, and right axillary lymph node dissection were performed. Immunohistochemical analysis revealed that the left breast cancer specimen was positive for estrogen receptor (ER) and progesterone receptor (PR), but negative for human epidermal growth factor receptor 2 (HER2). In contrast, the right axillary lymphadenopathy specimen was negative for ER and PR, but positive for HER2. Further investigation revealed no evidence of occult primary cancers or extra-mammary tumors. After surgical intervention, the patient was treated with adjuvant chemotherapy, adjuvant radiation therapy, and targeted therapy with trastuzumab. Two years after diagnosis, she is free of disease and presently being treated with tamoxifen.

Abstract P2-19-05: Oncoplastic breast conserving surgery with perforator flap in breast cancer patients

Purpose : Oncoplastic breast surgery has been used widely as a treatment protocol for breast cancer. Thoracodorsal artery perforator (TDAP) flap and intercostal artery perforator (ICAP) flap can provide adequate cover without sacrificing any muscle and allow closing of the donor sites in inconspicuous sites. Therefore, among the oncoplastic volume replacement techniques indicated using local flap that can adequately cover the volume of breast, TDAP and ICAP are especially suggested. This study describes the use of TDAP and ICAP flap techniques after breast conserving surgery. Methods : From March 2010 to August 2012, 38 patients with breast cancer received breast reconstruction. All patients who were selected had small- to moderate-sized defects on breasts, middle aged, and were not sensitive to scars. The TDAP flap is the first choice for performing the surgery, but if the perforator of the TDAP flap is not found, a dissection toward the anterior area to find an adequate perforator is made and the serratus anterior artery perforator is normally used. Otherwise after the dissection is performed more anterior, ICAP can be used. If the perforator penetrates the LD muscle, the TDAP flap can be used. The perforator that penetrates from the serratus anterior muscle is also used in the anterior area. Otherwise, ICAP can be used in partial breast reconstruction. The TDAP flap can be applied to any defect site regardless of the size of the defect area. Results : The mean age was 44.9 years and the average follow-up interval was 6 months. The average specimen weight was 98g. Complications developed in 4 cases including 3 cases of venous congestion, though self-limited, and 1 case of wound disruption on the inframammary fold suture area. Majority of the patients were satisfied with the cosmetic result.

Conclusion : Thoracodorsal artery perforator flap (TDAP) and intercostal artery perforator flap (ICAP) techniques can be reliable and useful in correcting breast deformity after breast conservation surgery, especially in patients with small- to moderate-sized defects on breasts.

Key Words : intercostal artery perforator flap, thoracodorsal artery perforator flap Oncoplastic surgery, ICAP, TDAP.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P2-19-05.

Abstract P6-05-24: Expression of aquaporin 5 and its polymorphisms predict survival in patients with early breast cancer

Background. Our previous study showed the association of AQP5 up-regulation with cancer proliferation and migration in hormone-responsive breast cancer cell lines (MCF-7) and with unfavorable prognosis in a small number of patients with breast cancer. Accordingly, we analyzed the prognostic impact of AQP5 expression and polymorphisms in a large number of patients with early breast cancer (EBC).

Methods. AQP5 expression was investigated based on the immunohistochemistry of tissue microarray specimens from 609 EBC patients who underwent surgery between 2003 and 2008. We scored the staining intensity (IS) and percentage of positive tumor cells (PC). The genomic DNA was extracted from paraffin-embedded tumor-free tissue and then genotyped for 3 polymorphisms (rs3736309, rs1964676, and rs74091167) using the Sequenom Mass array system.

Results. Among the 3 polymorphisms, AQP5 overexpression (IS + PC ≥6) was correlated with AQP5 rs74091167 GG genotype. AQP5 overexpression and AQP5 rs74091167 was significantly associated with disease-free survival (DFS; P < 0.001 and P = 0.021, respectively). Moreover, a multivariate survival analysis revealed that AQP5 overexpression and the GG genotype of AQP5 rs74091167 were significantly associated with DFS (HR = 2.026, 95% CI 1.058-3.881, P = 0.030; HR = 0.377, 95% CI 0.179-0.793, P = 0.010, respectively) adjusted to clinicopathological variables, which was prominent in patients with an ER/PgR-positive tumor.

Conclusions. Consistent with our previous study of breast cancer cell lines, AQP5 expression and AQP5 rs74091167 variant can be considered as a prognostic marker in patients with EBC after curative surgery. In the future, functional relevance of this variant needs to be clarified.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P6-05-24.

Abstract P5-17-02: Efficiency of methylene blue nanoparticles (nanoMB) as local injectable agent for photodynamic therapy in breast cancer

Photodynamic therapy (PDT), a non-invasive and alternative method for the treatment of cancer, is a light-activated treatment modality for breast cancer. Destruction of cancerous cells by PDT is achieved by a combination of photosensitizer and light of an appropriate wavelength for the photosensitizer.

Methylene blue (MB) is a blue dye clinically being used and is known to show efficient photosensitizing activity with a very high yield of singlet oxygen generation (65%), where singlet oxygen is the actual therapeutic agent for PDT. However MB shows low cell uptake efficiency by itself and thus a low PDT efficacy. In this regard, we developed a nanoformulation of MB (nanoMB) to improve cancer cell uptake efficiency while keeping the high efficiency of singlet oxygen generation. NanoMB is composed of ternary components that are physically assembled in an aqueous milieu.

In this study, we investigated the cellular uptake of nanoMB and cancer cell apoptosis induced by nanoMB PDT in MDA-MB-231 human breast cancer cells in vitro and in vivo.

In vitro, nanoMB was indeed avidly taken up by MDA-MB231 cells, unlike free MB showing negligible cellular uptake. NanoMB formulation preserved the photosensitization activity of MB under laser irradiation at 655 nm. Taken together, it was revealed from the in vitro microscopic observation that nanoMB can efficiently destroy live MDA-MB231 cells even under red lamp illumination. In the control group, cells were treated with free MB and did not show phototoxic influence under the same light.

In vivo phototoxicity evaluation, the locally injected nanoMB was internalized into cancer cells. Upon annexin V treatment after laser irradiation at 655 nm, apoptosis of cancer cells was clearly observed from the spot where nanoMB and laser were applied together. The PDT-induced cell apoptosis was visualized in a simple mouse model by using fluorescently labeled annexinV that has high affinity toward apoptotic cells.

Briefly, cancer cells were inoculated in muscle on opposite sides and nanoMB was applied to both the inoculation sites. After some time, only one side was laser-treated and fluorescent annexinV was injected to both. Only the dual-treated side (nanoMB + laser) showed retention of annexinV after 1 hour, indicating the occurrence of apoptosis by the PDT treatment.

Free MB and nanoMB were applied by subcutaneous injection around an early tumor tissue (not intratumoral injection). After 1 hour, free MB signals disappeared whereas nanoMB was retained at the tumor, implying that nanoMB penetrated into the tumor through the basement membrane.

Laser irradiation was done one hour after sample injection for both free MB and nanoMB. This treatment (sample + laser) was repeated seven times. According to the results, only nanoMB showed the tumor growth suppression effect, demonstrating the potential of nanoMB as a local injectable PDT agent.

In this study, nanoMB (MBOF) presented avid internalization into live cancer cells while keeping the high photosensitizing efficiency of MB. Consequently, highly efficient PDT of cancer cells was demonstrated in vitro and in vivo.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P5-17-02.

Abstract P1-01-24: Which combinations are helpful to predict axillary lymph node metastasis in T1 breast cancer with ultrasonography and contrast-enhanced MRI and contrast-enhanced 18F-FDG PET-CT?

Backgrounds: Axillary lymph node(ALN) status has been important factor of treatment and prognosis for patients with breast cancer. Even though the better ultrasonographic instruments have been developed, it is still difficult to predict axillary lymh node metastasis (ALNM) with only ultrasonography(US) in T1 breast cancers which most of newly diagnosed breast cancers are recently since T1 breast cancers have low rate and less tumor burden of ALNM. This study evaluated the accuracy of prediction of ALNM in T1 breast cancer with US, contrast-enhanced MRI (cMRI) and contrast-enhanced 18F-FDG PET/CT (cPET/CT) and found out adequate combinations of these modalities.

Method: Retrospectively, we reviewed 351 breast cancer patients with tumors(T1) ≤2cm in size between January 2008 and December 2011 who were preoperatively examined with US, cMRI, and cPET/CT and underwent pathologic evaluation of axillary lymph nodes acquired by sentinel lymph node biopsy or axillary dissection.

P2-16-15: Oncological Safety and Survival Rate According to Reconstructive Surgery in Advanced Breast Cancer after Neoadjuvant Chemotherapy

Purpose: Oncoplastic surgery has received attention according as the incidence of breast cancer is rising and quality of life including cosmetic result after surgery is regarded as important. The aim of this study is to compare combined reconstructive surgery with standard surgery regarding to oncological safety and survival rate in advanced breast cancer after neoadjuvant chemotherapy (CTx).

Method: Thirty-seven patients underwent neoadjuvant CTx and surgery with advanced breast cancer were analyzed from September 2007 to March 2010. Group A (n=12) received combined reconstructive surgery, group B (n=25) had standard surgery.

Results: There were no differences in age, size, metastatic LN, stage, ER/PR/Her-2 status, recurrence, metastasis and death between group A and B. Patients with good response in neoadjuvant chemotherapy (26 cases (72.9%)) had CTx-operation-radiation therapy (RTx), cases with poor response (10 cases (27.1%)) underwent CTx-RTx-operation. There was significant difference in order of treatment, eight patients among group A(66.6%) had CTx-RTx-operation, 22 cases in group B(88.0%) received CTx-operation-RTx (p=0.006). Mean follow up period was 22 months, 2 patients (5.2%) experienced local recurrences, 11 cases (34.3%) diagnosed with distant metastasis, and 4 patients (10.5%) expired with breast cancer.

Abstract P3-10-27: Caspase Variant as Prognostic Marker in Patients with Early Breast Cancer

Background: Since apoptosis induced by caspases may play a role in the prognosis of breast cancer, the present study analyzed the polymorphisms of caspase genes and their impact on the survival of 240 patients with early invasive ductal breast cancer.

Material and Methods: The genomic DNA was extracted from paraffin-embedded tumor-free tissue or blood, and 8 single nucleotide polymorphisms (SNPs) of 5 apoptosis-related genes in the apoptosis pathway determined using a Sequenom MassARRAY system. Results: During the median follow-up of 68.6 (range, 36.3-173.1) months, 43 relapses and 25 deaths occurred. Among the target polymorphisms, the caspase 9 gene polymorphism (CASP9 rs4645978) in a dominant model of the A allele was associated with survival in a log-rank test (P < 0.05). In a multivariate analysis, the GA+AA genotype of CASP9 rs4645978 was significantly correlated with a better disease-free survival (HR = 0.250; 95% CI = 0.075 - 0.840; P = 0.025), while marginally with distant disease-free or overall survival (HR = 0.360 and 0.337; P = 0.118 and 0.158, respectively). No clinicopathologic difference was observed according to the genotypes of this polymorphism. Discussion: The CASP9 rs4645978 was identified as a possible prognostic factor of survival in patients with operated invasive breast cancer.

Figures available in online version.

Dual endoscopic-assisted endoluminal colostomy reversal: a feasibility study

BACKGROUND

Emergent colostomies are associated with increased morbidity related to second closure operations. The purpose of this canine pilot study was to create a minimally invasive procedure that would reduce the time interval and morbidity involved with colostomy reversals after left colon end colostomies.

METHODS

Six mongrel dogs underwent modified laparoscopic Hartmann's procedures in which the stapled end of the rectal stump was approximated to the left colon proximal to the stoma. After 1 week, they underwent an endoluminal colostomy reversal with a computer-mediated, circular stapling device and varying anvil insertion methods. Variables recorded included anvil insertion technique and feasibility, OR time, complications, and number of days to first meal and bowel movement. A contrast enema performed 1 week post colostomy reversal ruled out anastomosis leaks and stenosis. The dogs were euthanized and subjected to necropsy.

RESULTS

Of four anvil insertion techniques tested, the most feasible employed a large-bore needle to perforate through the stapled end of the Hartmann pouch into the lumen of the left colon. Simultaneous endoluminal views of the rectal stump with a sigmoidoscope and the left colon lumen with an endoscope permitted a controlled and safe needle puncture. Through the needle, a guide wire was inserted to withdraw the anvil via the colostomy into place. A transanally inserted stapler was then married to the anvil under fluoroscopic guidance, thus completing the anastomosis. The colostomy was then taken down and transected at the level of the colocolostomy. Average operating time was 126 min (range 90-180), diet was tolerated within 1.5 days, and average number of days to first bowel movement was 2.5. The absence of stenosis, leaks, and inadvertent visceral injuries confirmed feasibility.

CONCLUSIONS

In this canine model, a dual endoscopic-assisted colostomy reversal with a computer-mediated, circular stapling device is feasible. Using this technique, colostomy reversals can possibly be performed 1 week post-colostomy without entering the peritoneal cavity, thus reducing the number of invasive operations and subsequent morbidity required to manage emergent colon perforations.

Laparoscopic harvesting of small bowel graft for small bowel transplantation

BACKGROUND

Small bowel transplantation represents a valid therapeutic option for patients with intestinal failure, obviating the need for long-term total parenteral nutrition. Recently, reports have shown the feasibility of performing living related intestinal transplantation using segmental small bowel grafts. The limitations of this technique include inadequate harvested small bowel lengths, as compared with the lengths obtained in cadaveric small bowel harvests, and large incisions for the donor. In this pilot study, we evaluated the feasibility of laparoscopically harvesting long segments of proximal jejunum for small bowel transplantation using a porcine model. The results can be used to evaluate the potential for applying this technique in human cases.

METHODS

For this study 10 yorkshire pigs were used. Under general anesthesia, each pig underwent laparoscopic segmental resection of 200 cm of proximal jejunum on a vascular pedicle. The harvested graft then was autoreimplanted using an open technique by anastomosing the vascular pedicle to the superior mesenteric vessels. Success was determined 2 hours after anastomosis by visually identifying a pink graft with viable-appearing mucosa, an artery with a strong thrill, and palpable venous flow. The animals were then sacrificed.

RESULTS

The mean operation time required to laparoscopically harvest the small bowel graft was 80 min (range, 35-120 min), and the mean length of harvested graft was 220 cm (range, 200-260 cm). The mean length of the graft's vascular pedicle was 4.5 cm (range, 4-5 cm). All 10 grafts were successfully harvested laparoscopically and then reimplanted using an open technique. All the grafts maintained good vascular flow, and showed no evidence of mucosal necrosis at necropsy. Obviously, further studies would be required to examine the long-term results of reimplanting a laparoscopically harvested small bowel graft, but proposals for such studies is beyond the scope of this report.

CONCLUSION

Minimally invasive techniques can be used to harvest proximal small bowel grafts for living related small bowel transplantation.

Cumulus cells apoptosis as an indicator to predict the quality of oocytes and the outcome of IVF-ET

PURPOSE

Our purpose was to establish an evaluation system for oocyte quality based on the incidence of cumulus cells apoptosis and to examine the effect of coculture, using autologous cumulus cells, on the outcome of IVF-ET according to proliferative activities of helper cells and the incidence of cumulus cells apoptosis.

METHODS

Cumulus cell masses were collected from 91 mature oocytes among 330 oocytes retrieved from a total of 34 IVF-ET cycles with tubal infertility and unexplained infertility. The incidence of apoptosis in cumulus cells was assessed by apoptosis detection kit fluorescein. On ovum pick up, 2nd day embryos were cocultured with autologous cumulus cells. Prior to coculture, in vitro proliferative activity of cumulus cells was evaluated.

RESULTS

Cumulus cells from patient groups over 40 years old had a significantly increased apoptosis incidence, a lower fertilization rate, and the decreased number of oocytes retrieved compared to the other age groups (P < .05). The incidence of cumulus cells apoptosis was significantly lower when the number of oocytes retrieved was 5 or less (P < .05). Cumulus cells from fertilized oocytes (0.43 +/- 0.07%) and those from patients who became pregnant (0.44 +/- 0.11%) following IVF-ET showed a significantly lower incidence of apoptosis compared to those of unfertilized oocytes (1.80 +/- 0.35%; P < .001) and the nonpregnant group (0.81 +/- 0.10%; P < .05). Embryo quality also had a negative correlation with the incidence of cumulus cells apoptosis. Coculture of fertilized oocytes with cumulus cells with high proliferative activity resulted in improved rates of implantation and pregnancy compared to that with poor active cumulus cells. No significant difference was found between the in vitro proliferative activity of cumulus cells and the incidence of cumulus cells apoptosis (P < .063).

CONCLUSIONS

The age of women might influence the incidence of apoptosis in cumulus cells, and the increased incidence of apoptosis is associated with the number of oocytes retrieved, the fertilization rate, and the pregnancy outcome following IVF-ET. These results suggest that the incidence of cumulus cells apoptosis can be used in predicting oocyte quality, outcome of IVF-ET, and age-related decline in fertility.

Toxic amebic colitis coexisting with intestinal tuberculosis

A patient with a fulminant amebic colitis coexisting with intestinal tuberculosis had a sudden onset of crampy abdominal pain, mucoid diarrhea, anorexia, fever and vomiting with signs of positive peritoneal irritation. Fulminant amebic colitis occurring together with intestinal tuberculosis is an uncommon event and may present an interesting patho-etiological relationship. The diagnosis was proven by histopathologic examination of resected specimen. Subtotal colectomy including segmental resection of ileum, about 80 cm in length, followed by exteriorization of both ends, was performed in an emergency basis. Despite all measures, the patient died on the sixth postoperative day. The exact relationship of fulminant amebic colitis and intestinal tuberculosis is speculative but the possibility of a cause and effect relationship exists. Fulminant amebic colitis may readily be confused with other types of inflammatory bowel disease, such as idiopathic ulcerative colitis, Crohn's disease, perforated diverticulitis and appendicitis with perforation. This report draws attention to the resurgence of tuberculosis and amebiasis in Korea, and the need for the high degree of caution required to detect it.

Laparoscopic procedures during the third trimester of pregnancy

Pregnancy no longer is considered to be an absolute contraindication for laparoscopic procedures. Furthermore, clinically helpful guidelines are in place for laparoscopic procedures during pregnancy. However, laparoscopic operations in women in the third trimester have not yet been reported fully. We successfully operated on torsion of an ovarian cyst in a woman during her third trimester using laparascopic procedure. The patient experienced an uneventful recovery.

Relationships between concentrations of tumor necrosis factor-alpha and nitric oxide in follicular fluid and oocyte quality

PURPOSE

Our objective was to explain a relationship between concentrations of tumor necrosis factor-alpha (TNF-alpha) and nitric oxide (NO) in follicular fluid, oocyte quality, and outcomes of in vitro fertilization--embryo transfer (IVF-ET).

METHODS

The concentrations of TNF-alpha and NO were measured in 115 follicular fluid samples collected from 43 patients undergoing IVF-ET program, due to tubal obstruction, some with endometriosis (8 patients) or hydrosalpinx (5 patients). A correlation of these factors concentrations and the oocyte quality, the oocyte maturity, and infertility-associated diseases was analyzed.

RESULTS

No correlation was found between concentrations of NO and TNF-alpha in follicular fluid. NO concentrations in follicular fluids were significantly higher in patients with endometriosis (P < 0.001) or hydrosalpinx (P < 0.01) compared to the patients with just tubal obstruction. Follicular NO concentration differences according to oocyte maturity and oocyte quality were not found. In contrast, TNF-alpha concentrations in follicular fluids were significantly higher in poor quality oocytes (P < 0.05) but were not associated with infertility-associated diseases, such as hydrosalphinx or endometriosis,and the oocyte maturity. No significant differences in follicular levels of NO and TNF-alpha as well as IVF-ET parameters of pregnant and nonpregnant groups were revealed.

CONCLUSIONS

There is no significant correlation between the concentrations of NO and TNF-alpha in follicular fluid. NO levels in follicular fluid are altered in infertility-associated diseases. However, TNF-alpha levels but not NO levels influence oocyte quality. These results suggest that the production of NO and TNF-alpha in follicular fluid may be regulated via different pathways and can be tempered with infertility-associated diseases, thereby influencing oocyte quality locally.

The development of reactor coolant pump vibration monitoring and a diagnostic system in the nuclear power plant

Monitoring abnormalities within reactor coolant pumps due to vibration, we introduce a Wigner distribution (WD) to a vibration monitoring system for analyzing vibration signals, and develop an on-line diagnostic method using the neural network employing back propagation algorithm. A rotor kit is used to simulate the abnormal conditions in the pump such as bearing rubbing, shaft bending, misalignment, etc. The data collected from the kit are analyzed using both a conventional system based on the Fourier transform (FT) and the software developed with the WD in this study, and they are compared. The study shows that spectrum represented by WD makes it easy to analyze the vibration signals of a rotating machine and the developed diagnostic method will help the operators grasp the cause of vibrations.

Ultrasonic inspection of studs (bolts) using dynamic predictive deconvolution and wave shaping

Bolt degradation has become a major issue in the nuclear industry since the 1980's. If small cracks in stud bolts are not detected early enough, they grow rapidly and cause catastrophic disasters. Their detection, despite its importance, is known to be a very difficult problem due to the complicated structures of the stud bolts. This paper presents a method of detecting and sizing a small crack in the root between two adjacent crests in threads. The key idea is from the fact that the mode-converted Rayleigh wave travels slowly down the face of the crack and turns from the intersection of the crack and the root of thread to the transducer. Thus, when a crack exists, a small delayed pulse due to the Rayleigh wave is detected between large regularly spaced pulses from the thread. The delay time is the same as the propagation delay time of the slow Rayleigh wave and is proportional to the site of the crack. To efficiently detect the slow Rayleigh wave, three methods based on digital signal processing are proposed: wave shaping, dynamic predictive deconvolution, and dynamic predictive deconvolution combined with wave shaping.

Systemic lupus erythematosus and Hodgkin's lymphoma

OBJECTIVE

Systemic lupus erythematosus (SLE) is associated with lymphoproliferative diseases such as Hodgkin's lymphoma. Since there is considerable overlap between the features of SLE and Hodgkin's lymphoma (SLE/HL) there can be a great difficulty in diagnosing Hodgkin's lymphoma in the presence of SLE. Our objective was to determine the features that can suggest coexistent SLE/HL:

METHODS

We describe 3 cases of Hodgkin's lymphoma that occurred in the setting of SLE and review the features of 11 reported cases in which the diseases occurred simultaneously. We compare the features of these cases with those of Hodgkin's lymphoma and SLE occurring alone.

RESULTS

Mediastinal adenopathy was seen in 58% and retroperitoneal adenopathy in 17% of patients with SLE/HL, while it was seen only rarely in these sites in cases with SLE. Severe generalized pruritus, which occurs in only 2.8% of cases of SLE, was seen in 63% of cases with SLE/HL: Features such as fever, weight loss, peripheral lymphadenopathy, splenomegaly and hepatomegaly are common to both Hodgkin's lymphoma and SLE. Renal disease is seen in half of the cases of SLE. It is rare in Hodgkin's lymphoma where, unlike SLE, it is only of minimal change or membranous type. Arthritis and positive antinuclear antibodies are rare in Hodgkin's lymphoma.

CONCLUSIONS

Persistent lymphadenopathy, especially mediastinal and/or retroperitoneal lymphadenopathy, eosinophilia and generalized pruritus in a patient with SLE not responding to treatment may be indicative of coexistent Hodgkin's lymphoma.

Nonperturbative diffraction tomography via Gauss-Newton iteration applied to the scattering integral equation

A nonperturbational inverse scattering solution for the scattering integral equation (SIE) is presented. The numerical discretization of the SIE is performed by the moment method (MM) using sinc basis functions. Previous algorithms using the alternating variable (AV) nonlinear iteration with algebraic reconstruction technique (ART) solution of the linearizations are shown to diverge for high contrast/large size acoustic scatterers. This deficiency is alleviated by the use of the Gauss-Newton (GN) nonlinear iteration with conjugate gradient (CG) solution of the linearizations. Further numerical efficiency is attained by use of the biconjugate gradient (BCG) algorithm to solve the forward scattering problems. Test problem reconstructions of circular cylinders, using the Bessel series analytic solution to generate the scattering data, demonstrate the accuracy of the method. Inhomogeneous models of human cross-sections verify the high spatial resolution and high speed of sound contrast capability of the method.

Evaluation of long-term dietary intakes of adults consuming self-selected diets

Mean daily intakes of calories and 19 nutrients were calculated for 13 males and 16 females, ages 20 to 53 yr, who kept daily diet records for 1 yr. Mean daily caloric and 19 selected nutrient intakes of the subjects met or exceeded the 1980 recommended dietary allowances except for iron and calcium for females. Males had higher intakes than females for all nutrients studied except crude fiber, vitamin A, and vitamin C. However, nutrient density values were comparable for both sexes, except that the females had higher nutrient density values for vitamin A than did the males. The younger subjects had higher intakes of calories and saturated fat than the older ones. The younger males had higher intakes of total fat, saturated fat, and oleic acid than the older males. The consistency of reporting food intakes examined by applying a systematic sampling method designed for this study did not vary considerably when diet records kept over a long period of time were evaluated by four methods.

Effect of making duplicate food collections on nutrient intakes calculated from diet records

In a 1-yr study in which food intakes were recorded daily, subjects were asked to make duplicate food collections for 1 wk during each of the four seasons. Mean calculated energy intake of the 29 subjects was 12.9% less during the food collection periods than the mean for the entire year (which included collection periods). There were also significant reductions in the reported intake of all nutrients during the collection periods. Protein, vitamin A, saturated fat, and cholesterol intakes were decreased to the greatest extent. The actual decrease in energy intake was greater for the males than for the females, but the percentage was the same (12.9%). The younger group of subjects (less than or equal to 35) decreased energy intake 16.8% and the older group (greater than 35) 8.8%. Comparison of intakes during collection periods with intakes the week before and the week after showed that 28 of the 29 subjects decreased their energy intake from 1.1 to 32.3%. These data suggest that intakes of subjects during food collection periods do not represent their habitual levels of intake reported throughout the year.

Relationships among dietary constituents and specific serum clinical components of subjects eating self-selected diets

Sex- and age-related differences in dietary and blood chemistry factors were investigated in subjects adhering to their usual lifestyles. Diet records were examined daily and blood chemistry profiles were monitored five times during the 1-yr study. As expected, high-density lipoprotein cholesterol was significantly higher in women than in men. Values of creatine phosphokinase, aspartic aminotransferase, alanine aminotransferase, glucose, triglycerides, urea nitrogen, uric acid, and total bilirubin were higher in men than in women. Glucose was lower while high-density lipoprotein cholesterol, albumin, and total protein were higher in the younger women than in older women. Alcohol consumption by men correlated positively with aspartic aminotransferase and alanine aminotransferase but not with high-density lipoprotein cholesterol. Alcohol consumption by women did correlate positively with high-density lipoprotein cholesterol but not with the aminotransferase enzymes. Correlations between serum high-density lipoprotein cholesterol and vitamin C intake were positive and significant in women. In men, high levels of high-density lipoprotein cholesterol seems to be associated with very high vitamin C intakes, but no associations were apparent at normal levels of these parameters. Serum cholesterol did not correlate significantly with dietary cholesterol, saturated fat, linoleic acid, or P/S in men or women.

Magnesium intakes, balances, and blood levels of adults consuming self-selected diets

Magnesium balances and plasma and blood cell concentrations were determined in 34 men and women, 20 to 53 yr of age, during each season for 1 yr while they were consuming their customary diets. Dietary records were maintained 365 days. Analysis of variance indicated no seasonal variation in intake or balance. Blood cell magnesium correlated with magnesium intake (r2 = 0.203; p less than 0.04). Daily magnesium intakes of the men (323 mg) were significantly higher (p less than 0.01) than of the women (234 mg), and reflected greater calorie consumption for their greater body weights. Daily magnesium balances for the men and women were -32 and -25 mg, respectively. Multiple regression analysis showed that magnesium balance was associated not only with magnesium intake but also with the intake of other nutrients such as fiber, protein, calcium, and phosphorus. Moreover, the effect of these nutrients on magnesium balance varied with age and sex.