CT features combined with RECIST 1.1 criteria improve progression assessments of sunitinib-treated gastrointestinal stromal tumors

OBJECTIVES

To explore the auxiliary value of combining CT features with existing response evaluation criteria in the prediction of progressive disease (PD) in gastrointestinal stromal tumors (GIST) patients treated with sunitinib.

MATERIAL AND METHODS

Eighty-one patients with GISTs who received sunitinib were included in this retrospective multicenter study and divided into training and external validation cohorts. Progression at six months was determined as a reference standard. The predictive performance of the RECIST 1.1 and Choi criteria was compared. CT features at baseline and the first follow-up were analyzed. Logistic regression analyses were used to determine the most significant predictors and develop modified criteria.

RESULTS

A total of 216 lesions showed a good response and 107 showed a poor response in 81 patients. The RECIST 1.1 criteria performed better than the Choi criteria in predicting progression (AUC, 0.75 vs. 0.69, p = 0.04). The expanded/intensified high-enhancement area, blurred tumor-tissue interface, and progressive enlarged vessels feeding or draining the mass (EVFDM) differed significantly between lesions with good and poor responses in the training cohort (p = 0.001, 0.003, and 0.000, respectively). Multivariate analysis revealed that the expanded/intensified high-enhancement area (p = 0.001), progressive EVFDM (p = 0.000), and RECIST PD (p = 0.000) were independent predictive factors. Modified RECIST (mRECIST) criteria were developed and showed significantly higher AUCs in the training and external validation cohorts than the RECIST 1.1 criteria (training: 0.81 vs. 0.73, p = 0.002; validation: 0.82 vs. 0.77, p = 0.04).

CONCLUSION

The mRECIST criteria, combining CT features with the RECIST 1.1 criteria, demonstrated superior performance in the prediction of early progression in GIST patients receiving sunitinib.

CLINICAL RELEVANCE STATEMENT

The mRECIST criteria, which combine CT features with the RECIST 1.1 criteria, may facilitate the early detection of progressive disease in GIST patients treated with sunitinib, thereby potentially guiding the timely switch to late-line medications or combination with surgical excision.

KEY POINTS

• The RECIST 1.1 criteria outperformed the Choi criteria in identifying progression of GISTs in patients treated with sunitinib. • GISTs displayed different morphologic features on CT depending on how they responded to sunitinib. • Combining CT morphologic features with the RECIST 1.1 criteria allowed for the prompt and accurate identification of progressing GIST lesions.

Characterization of a Human Gastrointestinal Stromal Tumor Cell Line Established by SV40LT-Mediated Immortalization

Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors in the digestive tract and originate from the interstitial cells of Cajal (ICC), which is the pacemaker for peristaltic movement in the gastrointestinal tract. Existing GIST cell lines are widely used as cell models for in vitro experimental studies because the mutation sites are known. However, the immortalization methods of these cell lines are unknown, and no Chinese patient-derived GIST cell lines have been documented. Here, we transfected simian virus 40 large T antigen (SV40LT) into primary GIST cells to establish an immortalized human GIST cell line (ImGIST) for the first time. The ImGIST cells had neuronal cell-like irregular radioactive growth and retained the fusion growth characteristics of GIST cells. They stably expressed signature proteins, maintained the biological and genomic characteristics of normal primary GIST cells, and responded well to imatinib, suggesting that ImGIST could be a potential in vitro model for research in GIST to explore the molecular pathogenesis, drug resistance mechanisms, and the development of new adjuvant therapeutic options.

Role of HMGB1 in the formation of chronic thromboembolic pulmonary hypertension after acute pulmonary embolism

Acute pulmonary embolism (PE) may be a common but fatal condition in several countries; in untreated or inadequately therapeutic PE patients, is a commonly occurring long-term complication affecting patient survival treatment and prognosis, contributing to right heart disease and may even be fatal. To date, the pathogenesis of chronic thromboembolic pulmonary hypertension (CTEPH) due to acute pulmonary embolism remains unclear; hence, there is an immediate demand for medications that are directly aimed at both preventing and managing the progression of CTEPH. Previous studies have shown that the inflammatory response is associated with thrombosis and the development of pulmonary cardiovascular disease. High-mobility Group B 1 (HMGB1), a damage-associated molecular pattern (DAMP), is involved in deep vein thrombosis and inflammatory reactions, vascular remodeling, and thrombosis in pulmonary hypertension. Therefore, we hypothesized that HMGB1 participates in the process of CTEPH development after acute PE. This paper details the dynamic changes in HMGB1 and the relationship between HMGB1 and the advancement of CTEPH after acute PE to better understand the pathogenic mechanisms and potential clinical applications.

Advances in the research of the mechanism of secondary resistance to imatinib in gastrointestinal stromal tumors

Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract. At present, surgery is the first-line treatment for primary resectable GISTs; however, the recurrence rate is high. Imatinib mesylate (IM) is an effective first-line drug used for the treatment of unresectable or metastatic recurrent GISTs. More than 80% of patients with GISTs show significantly improved 5-year survival after treatment; however, approximately 50% of patients develop drug resistance after 2 years of IM treatment. Therefore, an in-depth research is urgently needed to reveal the mechanisms of secondary resistance to IM in patients with GISTs and to develop new therapeutic targets and regimens to improve their long-term prognoses. In this review, research on the mechanisms of secondary resistance to IM conducted in the last 5 years is discussed and summarized from the aspects of abnormal energy metabolism, gene mutations, non-coding RNA, and key proteins. Studies have shown that different drug-resistance mechanism networks are closely linked and interconnected. However, the influence of these drug-resistance mechanisms has not been compared. The combined inhibition of drug-resistance mechanisms with IM therapy and the combined inhibition of multiple drug-resistance mechanisms are expected to become new therapeutic options in the treatment of GISTs. In addition, implementing individualized therapies based on the identification of resistance mechanisms will provide new adjuvant treatment options for patients with IM-resistant GISTs, thereby delaying the progression of GISTs. Previous studies provide theoretical support for solving the problems of drug-resistance mechanisms. However, most studies on drug-resistance mechanisms are still in the research stage. Further clinical studies are needed to confirm the safety and efficacy of the inhibition of drug-resistance mechanisms as a potential therapeutic target.

Gut microbiome is more stable in males than in females during the development of colorectal cancer

AIMS

Gut microbial alterations have great potential to predict the development of colorectal cancer (CRC); however, how gut microbes respond to the development of CRC in males and females at the community level is unknown. We aim to investigate the differences of gut microbiota between the male and female.

METHODS AND RESULTS

We reanalysed the dataset in a published project from a sex perspective at the community level by characterizing the gut microbiome in patients (including males and females) from three clinical groups representative of the stages of CRC development: healthy, adenoma, and carcinoma. The results indicated that the microbial α-diversity showed no significant difference in the male gut but had decreased significantly in the female gut with the development of CRC. In males, a significant difference in the microbial β-diversity was only observed between the healthy and carcinoma subgroups. However, significant community deviations were detected with the development of CRC in females. The microbial community assembly processes changed from deterministic to stochastic in males, whereas they became increasingly deterministic in females with the development of CRC. Moreover microbial co-occurrence associations tended to be more complicated in males; rare species were enriched in the co-occurrence network of the male gut, whereas key species loss was observed in the co-occurrence network of the female gut.

CONCLUSIONS

The microbial communities in the male gut were more stable than those in the female gut, and microbial community assembly in the gut was sex dependent with the development of CRC. Our study suggests that sexual dimorphism needs to be considered to better predict the risk of CRC based on microbial shifts.

SIGNIFICANCE AND IMPACT OF THE STUDY

To the best of our knowledge, this is the first report showing how gut microbes respond to the development of CRC in males and females at the community scale.

Interleukin-4 Restores Insulin Sensitivity in Insulin-Resistant Osteoblasts by Increasing the Expression of Insulin Receptor Substrate 1

Obesity and latent inflammation can give rise to insulin resistance and type 2 diabetes. Here we established an insulin resistance model of osteoblasts to explore the restoration effect of anti-inflammatory interleukin-4 (IL-4) on insulin sensitivity and its mechanism. We found that IL-4 inhibited cell proliferation in a concentration- and time-dependent manner. Insulation resistance significantly reduced the phosphorylation levels of the insulin receptor substrate 1 (IRS1; Tyr612), Akt (Ser473), and AS160 (Ser318) proteins. The addition of IL-4 to the insulin resistance model led to a dose-dependent stimulation of the phosphorylation of IRS1, Akt, and AS160. IL-4 fully restored the activation of the insulin cascade in insulin-resistant cells at the concentration of 50 ng/ml. Additionally, IL-4 promoted the expression of IRS1 in a time-dependent manner. We conjecture that IL-4 restores insulin sensitivity in osteoblasts by upregulating the expression of IRS1. It was also found that IL-4 promoted the expression of osteoprotegerin depending on the time of exposure. This effect may play an important role in the regulation of the energy metabolism in the whole body.

Why hasn't this woman been screened for breast and cervical cancer? - Evidence from a Chinese population-based study

OBJECTIVE

Less than half of eligible Chinese rural women have been screened for breast and cervical cancer. The objective of this study was to describe individual-level reasons for attending or not attending 'two cancers' screening using Andersen's Behavioral Model of Health Services Use.

STUDY DESIGN

Cross-sectional study.

METHODS

The study sample was from the Health Services Survey in 2013 in Jiangsu, China. A total of 6520 rural women aged 36-65 years answered the questions on 'two cancers' screening participation and were included in the final analysis, which consisted of univariate and multivariate logistic regression.

RESULTS

In the results of multivariate logistic regression, factors significantly associated with having 'two cancers' screening included educational level (odds ratio [OR] = 0.78, 95% confidence interval [CI] = 0.65-0.92), per capita household income (OR = 0.65, 95% CI = 0.58-0.73), availability of female medical faculty in township facilities (OR = 0.35, 95% CI = 0.28-0.42), quality of life (OR = 0.72, 95% CI = 0.58-0.90), being nulliparous (OR = 3.21, 95% CI = 1.96-5.26), and multiparous (OR = 1.91, 95% CI = 1.68-2.16).

CONCLUSION

To reduce inadequate screening service utilization of breast and cervical cancer in rural areas, efforts should be made not only to target the vulnerable rural women with lower income, lower educational level, and lower health conditions but also to further improve access to female primary-care providers. Strategies are also urgently needed to focus on nulliparous and multiparous women.

Serum miR-518e-5p is a potential biomarker for secondary imatinib-resistant gastrointestinal stromal tumor

Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumor of the intestinal tract. Imatinib is used as first-line therapy for GIST patients; however, secondary imatinib resistance poses a significant clinical challenge. Here, we analyzed serum miRNA expression profiles to identify specific serum miRNAs that could be used as early diagnostic markers. Candidate miRNAs were validated using Taqman quantitative PCR with serum samples from secondary imatinibresistant GIST patients (n = 39), imatinib-sensitive GIST patients (n = 37), and healthy controls (n = 28). Serum miR- 518e-5p and miR-548e levels were higher in secondary imatinib-resistant GIST than imatinib-sensitive GIST patients or healthy controls (P less than 0.0001). However, ROC analysis indicated that only miR-518e-5p could distinguish imatinibresistant GIST. To discriminate imatinib-resistant from imatinib-sensitive GIST patients, the AUC for serum miR-518e-5p was 0.9938, with 99.8% sensitivity and 82.1% specificity. Serum miR-518e-5p could also discriminate imatinib-resistant GIST patients from healthy controls with 99.9% sensitivity and 97.4% specificity. These data indicate that serum miR-518e- 5p is a potentially promising non-invasive biomarker for early detection and diagnosis of secondary imatinib-resistant GIST.

Cytoreductive surgery for metastatic gastrointestinal stromal tumors followed by sunitinib compared to followed by imatinib-a multi-center cohort study

BACKGROUND

The progression-free survival (PFS) is not optimal when imatinib was recommended for treatment of gastrointestinal stromal tumor (GIST) undergoing surgery after tumor local or multifocal progression.

METHODS

We evaluate PFS of patients undergoing R0 resection or optimal cytoreductive surgery followed by sunitinib therapy compared with imatinib after tumor unifocal or multifocal progression.

RESULTS

From January 2006 to June 2017, ninety-seven patients from thirteen medical centers were enrolled. Fifty-six patients continued imatinib therapy and 41 patients switched sunitinib treatment directly after R0 resection or optimal cytoreductive surgery. The PFS of sunitinib group was longer than that of imatinib group (30.0 months vs 12.0 months, p = 0.009). In subgroup analysis, the PFS of the sunitinib and imatinib groups were 25.5 months and 12.0 months in patients with tumor multifocal progression (p = 0.008), and 39.0 months and 13.0 months in patients with unifocal progression (p = 0.156), respectively. PFS of postoperative sunitinib group was also superior to the total PFS of postoperative imatinib group (PFS of postoperative imatinib plus PFS of subsequent sunitinib therapy (30.0 months vs 21.0 months, p = 0.012). The overall survival in the sunitinib and imatinib groups were 37.0 months and 33.0 months, respectively (p = 0.794).

CONCLUSIONS

Surgery followed by sunitinib in GIST patients with unifocal or multifocal progression on imatinib may improve PFS, compared with surgery followed by imatinib.

Enlargement of the WHO international repository for platelet transfusion-relevant bacteria reference strains

BACKGROUND AND OBJECTIVES

Interventions to prevent and detect bacterial contamination of platelet concentrates (PCs) have reduced, but not eliminated the sepsis risk. Standardized bacterial strains are needed to validate detection and pathogen reduction technologies in PCs. Following the establishment of the First International Reference Repository of Platelet Transfusion-Relevant Bacterial Reference Strains (the 'repository'), the World Health Organization (WHO) Expert Committee on Biological Standardisation (ECBS) endorsed further repository expansion.

MATERIALS AND METHODS

Sixteen bacterial strains, including the four repository strains, were distributed from the Paul-Ehrlich-Institut (PEI) to 14 laboratories in 10 countries for enumeration, identification and growth measurement on days 2, 4 and 7 after low spiking levels [10-25 colony-forming units (CFU)/PC bag]. Spore-forming (Bacillus cereusPEI-B-P-07-S, Bacillus thuringiensisPEI-B-P-57-S), Gram-negative (Enterobacter cloacaePEI-B-P-43, Morganella morganiiPEI-B-P-74, PEI-B-P-91, Proteus mirabilisPEI-B-P-55, Pseudomonas fluorescensPEI-B-P-77, Salmonella choleraesuisPEI-B-P-78, Serratia marcescensPEI-B-P-56) and Gram-positive (Staphylococcus aureusPEI-B-P-63, Streptococcus dysgalactiaePEI-B-P-71, Streptococcus bovisPEI-B-P-61) strains were evaluated.

RESULTS

Bacterial viability was conserved after transport to the participating laboratories with one exception (M. morganiiPEI-B-P-74). All other strains showed moderate-to-excellent growth. Bacillus cereus, B. thuringiensis, E. coli, K. pneumoniae, P. fluorescens, S. marcescens, S. aureus and S. dysgalactiae grew to >10⁶ CFU/ml by day 2. Enterobacter cloacae, P. mirabilis, S. epidermidis, S. bovis and S. pyogenes achieved >10⁶ CFU/ml at day 4. Growth of S. choleraesuis was lower and highly variable.

CONCLUSION

The WHO ECBS approved all bacterial strains (except M. morganiiPEI-B-P-74 and S. choleraesuisPEI-B-P-78) for repository enlargement. The strains were stable, suitable for spiking with low CFU numbers, and proliferation was independent of the PC donor.

Direct loop gain and bandwidth measurement of phase-locked loop

A simple and robust technique for directly measuring the loop gain and bandwidth of a phase-locked loop (PLL) is proposed. This technique can be used for the real-time measurement of the real loop gain in a closed PLL without breaking its locking state. The agreement of the measured loop gain and theoretical calculations proves the validity of the proposed measurement technique. This technique with a simple configuration can be easily expanded to other phase-locking systems whose loop gain and bandwidth should be measured precisely.

Comparison of Gene Expression Profile Between Tumor Tissue and Adjacent Non-tumor Tissue in Patients with Gastric Gastrointestinal Stromal Tumor (GIST)

Gastrointestinal stromal tumors (GISTs) are defined as spindle cell and/or epithelioid tumors originated from interstitial Cajal cells or precursors in the digestive tract. This study was conducted to identify genes differing in expression between the gastric tumors and the adjacent non-cancerous mucosas in patients with primary gastric GIST. The gene expression profile was determined by using oligonucleotide-based DNA microarrays and further validated by quantitative real-time PCR. The Kyoto encyclopedia of genes and genomes (KEGG) pathway analysis was performed to predict signaling pathways involved in gastric GIST. Our data showed that the expression levels of 957 genes (RAB39B, member RAS oncogene family; VCAN, versican; etc.) were higher and that of 526 genes (CXCL14, chemokine C-X-C motif ligand 14; MTUS1, microtubule-associated tumor suppressor 1; etc.) were lower in the gastric tumor tissues as compared with normal gastric tissues. Results from KEGG pathway analysis revealed that the differentially expressed genes were enriched into 16 signaling transduction pathways, including Hedeghog and Wnt signaling pathways. Our study may provide basis for identification of novel biomarkers associated with primary gastric GIST pathogenesis and for exploration of underlying mechanisms involved in this gastric sarcoma.

Inhibition of miR-23 protects myocardial function from ischemia-reperfusion injury through restoration of glutamine metabolism

OBJECTIVE

Myocardial disorders caused by ischemia/reperfusion (IR) continue to be among the most frequent causes of debilitating disease and death. The contribution of cellular metabolism through the production of metabolic intermediates during IR has been increasingly investigated.

MATERIALS AND METHODS

In this study, by using a rat IR injury model, we reported that the expression of microRNA miR-23 was induced by IR. In contrast, the glutamine metabolism was suppressed during IR. The glutamate, glutamine dehydrogenase activity, α-ketoglutarate, and glutaminase (GLS) mRNA expression were significantly decreased by IR. Moreover, the pretreatment of glutamine could protect the myocardium from IR injury.

RESULTS

From microRNA target prediction analysis and results of luciferase assay, we found that miR-23 could directly target the 3'UTR of GLS. Finally, we demonstrated that inhibition of miR-23 protected myocardial function from IR through the restoration of glutamine metabolism.

CONCLUSIONS

This study reveals that inhibition of miR-23 renders protective effects on rat IR injury, highlighting the importance of miR-23 and glutamine metabolism during IR, and suggests a potentially clinical benefit.

Role of selenoprotein S (SEPS1) -105G>A polymorphisms and PI3K/Akt signaling pathway in Kashin-Beck disease

OBJECTIVE

To investigate the relationship between SEPS1 polymorphism and phosphatidylinositol 3-kinase (PI3K)/Akt signaling pathway in Kashin-Beck disease (KBD) and further explore the pathogenesis of KBD.

METHODS

Polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) was used to detect SEPS1 -105G>A polymorphism in 232 cases and 331 controls. The protein expressions of PI3K/Akt signaling molecules in whole blood and chondrocytes were detected by Western blot.

RESULTS

The frequencies of SEPS1 -105G>A genotype AA (21.1% vs 3.0%) and minor allele A (34.1% vs 16.0%) in KBD are significantly higher than those in controls (OR: 8.020, 95% confidence interval (95% CI) 6.341-10.290, P < 0.0001; OR: 2.470, 95% CI 2.001-4.463, P < 0.0001, respectively). SEPS1 AA genotype was an independent risk factor for KBD (adjusted OR: 9.345, 95% CI 4.254-20.529; P < 0.0001). The expression of Gβγ, PI3Kp110, pAkt and pGSK3β in KBD group were higher than that in control group (all P < 0.05). Gβγ, pAkt and pGSK3β protein expression of AA and GA increased than GG (all P < 0.05). Cell apoptosis was increasing and molecule expression of PI3K/Akt signaling pathway were up-regulated in the tert-Butyl hydroperoxide (tBHP)-injured group, the cell apoptosis and expression levels of PI3K/Akt in Na2SeO3 group were decreased.

CONCLUSIONS

The SEPS1 -105G>A is associated with an increased risk of KBD and influences the expression of PI3K/Akt signaling pathway in KBD patients. Apoptosis induced by tBHP in chondrocyte might be mediated via up-regulation of PI3K/Akt, Na2SeO3 has an effect of anti-apoptosis by down-regulating of PI3K/Akt signaling pathway.

Evaluation of a universal point-of-issue assay for bacterial detection in buffy coat platelet components

Bacterial contamination of platelet concentrates poses a major post-transfusion infectious risk. This study was aimed at evaluating the efficacy of the BacTx(®) assay (Immunetics Inc.) for bacterial detection in leucocyte-reduced buffy coat platelet pools and for its sensitivity in detecting clinical isolates, including bacteria that form surface-attached aggregates (biofilm positives). Platelet pools were inoculated at bacterial concentrations of 0·8-13 CFU/ml. The BacTx(®) assay detected all species at concentrations ≥10(3)  CFU/ml within 20-69 h of platelet incubation. Detection of slow-growing and biofilm-forming strains was delayed in comparison with the other strains. This assay could be used as a point-of-issue method to increase the safety of the platelet supply.

Relationship of Porphyromonas gingivalis with glycemic level in patients with type 2 diabetes following periodontal treatment

INTRODUCTION

The aim of this study was to assess the relationship between serum glycemic levels and subgingival microbial profile alteration following periodontal treatment in patients with type 2 diabetes mellitus.

METHODS

We studied 30 periodontitis patients with type 2 diabetes mellitus who received full-mouth subgingival debridement by analyzing their subgingival microbial profiles using a polymerase chain reaction method at baseline and various time-points for 12 months following treatment. Concurrently, probing pocket depth, bleeding on probing, and metabolic parameters, including glycated hemoglobin A1c (HbA1c), blood sugar level, C-reactive proteins, total cholesterol, triglyceride, and high-density and low-density lipoprotein cholesterol, were recorded.

RESULTS

Periodontal conditions were significantly improved after treatment, and the occurrence rates of periodontal bacterial species, including Porphyromonas gingivalis, Tannerella forsythensis, Treponema denticola, and Prevotella intermedia, were also reduced. Interestingly, P. gingivalis was detected more frequently in subjects with increased HbA1c values after periodontal treatment than in those patients with decreased HbA1c values. Furthermore, P. gingivalis with type II fimbriae was detected only in HbA1c-increased subjects, while improvements in HbA1c values were observed only in subjects without type II clones.

CONCLUSIONS

These results suggest that glycemic level in diabetes is affected by the persistence of P. gingivalis, especially clones with type II fimbriae, in periodontal pockets.

Pollination of Cypripedium plectrochilum (Orchidaceae) by Lasioglossum spp. (Halictidae): the roles of generalist attractants versus restrictive floral architecture

The pollination of Cypripedium plectrochilum Franch. was studied in the Huanglong Nature Reserve, Sichuan, China. Although large bees (Bombus, Apis), small bees (Ceratina, Lasioglossum), ants (Formica sp.), true flies (Diptera) and a butterfly were all found to visit the flowers, only small bees, including three Lasioglossum spp. (L. viridiclaucum, L. sichuanense and L. sp.; Halictidae) and one Ceratina sp., carried the flower's pollen and contacted the receptive stigma. Measurements of floral architecture showed that interior floral dimensions best fit the exterior dimensions of Lasioglossum spp., leading to the consistent deposition and stigmatic reception of dorsally-placed, pollen smears. The floral fragrance was dominated by one ketone, 3-methyl-Decen-2-one. The conversion rate of flowers into capsules in open (insect) pollinated flowers at the site was more than 38%. We conclude that, while pigmentation patterns and floral fragrance attracted a wide variety of insect foragers, canalization of interior floral dimensions ultimately determined the spectrum of potential pollinators in this generalist, food-mimic flower. A review of the literature showed that the specialised mode of pollination-by-deceit in C. plectrochilum, limiting pollinators to a narrow and closely related guild of 'dupes' is typical for other members of this genus.

Mobility characterization of waxy corn starch using wide-line (1)H nuclear magnetic resonance

The molecular mobility of waxy corn starch was studied by using wide-line (1)H nuclear magnetic resonance (NMR) spectroscopy. A suite of NMR techniques was used to measure relaxation times (i.e., T(2), T(2), and T(1)) and to characterize water and solid (starch) mobility of waxy corn starch. It was observed that the spectrum of each sample includes a complex broad proton component upon which is superimposed a narrow proton component over water activity (a(w)) ranges from 0.33 to 0.97 (i.e., 10.-25.6% water content) at 25 degrees C. Line shape analysis and relaxation times of both broad and narrow components show that T(2) and T(2) values decrease (i.e., decreasing mobility) with increasing solid concentration and show a "break point" in a concentration range between 19.8 and 21.9% water content. The T(1) shows a "T(1) minimum" in the same concentration range. Starch samples change from the glassy to viscous rubbery state in this same concentration range. This demonstrates that wide-line (1)H NMR relaxation times (i.e., T(2), T(2), and T(1)) may be useful as indicators of glass transition for starch samples in the solid state. The results demonstrate that wide-line (1)H NMR spectroscopy is able to separate modes and quantitate the magnitude of molecular mobility in complex systems.

[Gas chromatography-infrared spectroscopy(GC-IR) analysis of the oxidation products of cyclohexene]

Gas chromatography-infrared spectroscopy technique integrates the excellent resolution ability of GC with the structural information of IR. Based on the GC and IR spectra, the complicated products of a reaction can be analyzed quantitatively and qualitatively. From the analysis of the products, the reaction process and its mechanism can be elucidated. In this work, analysis by GC-IR of the oxidation products of cyclohexene catalyzed by zeolite TS-1 in H2O2 was performed. The products are 2-cyclohexenone, 2-cyclohexen-1-ol and 2,3-epoxy-1-cyclohexanone. 2,3-Epoxy-1-cyclohexanone is an unexpected product. It must be a further oxidation product of 2-cyclohexenone. From the analysis, the reaction mechanisms were presumed.

[Effect of GG on the occurrence of tongue retropulsion--an experimental observation of electromyography]

To evaluate the effect of GG activity on tongue backwardness during sleep, we conducted experiments on 16 rabbits. The electric activities of the muscles involved in tongue motion were recorded in different phases (wakefulness, presnoring and snoring) with unipolar electrodes inserted into the muscles under direct vision. The observations demonstrated that GG played a more active role in the occurrence of tongue backwardness during sleep.

[The comparison of absorptive routes of intraperitoneal infusion with cisplatin in dogs]

Dogs weighing between 10 and 15 kg were used, and cisplatin was given at a dose of 2 mg/kg. The dogs were infused ip with either 100 ml (A groups) or 200 ml (B groups) of physiological salt solution containing cisplatin. The cisplatin concentrations in serum (peripheral and portal blood), and liver tissues were measured with limited filtration using MPS of AMICON (free-CDDP). The total CDDP concentration was also determined. Blood was collected at 30 minutes, and 1, 2, 3, 4, 5 and 6 hours after ip administration. The following results were obtained: 1) A high concentration of free-CDDP (AUC) was observed in the portal blood of A groups. 2) Peripheral serum level (total-CDDP) was increased in the B groups. 3) Total CDDP level within the liver tissues was higher in the A groups. It is concluded that ip cisplatin therapy with moderate volume solution may be effective for liver metastasis of gastric cancer for delivery to the liver tissue.

[Pharmacokinetics following intraperitoneal infusion of cisplatinum with and without sodium thiosulfate rescue in carcinomatous peritonitis in advanced gastric cancers]

The pharmacokinetics of ip cisplatinum (100 mg/body) was studied in 10 patients with advanced gastric cancer. Five patients were administered ip-cisplatinum with STS and another 5 patients were given the same without STS. As a result, 1) the level of free-CDDP in ascites fluid was significantly elevated after administration, showing that free-CDDP possessing anti-tumor activity persisted in the ascites fluid for a long time and reached the peak concentration 30 minutes after administration. 2) The free-CDDP transferred into the blood after administration also persisted for a long time in parallel with changes in the free-CDDP level in the ascites fluid. 3) The AUC, MRT and VRT of the free-CDDP concentration in the peritoneal cavity after ip administration of CDDP were high, clearly indicating the direct effect on peritoneal concentration. 4) The AUC, MRT and VRT of free-CDDP in the venous phase after ip administration of CDDP were higher than after its iv administration, suggesting that effects equivalent to or greater than those of the iv route drug can be expected in the venous phase. 5) The frequency of side effects induced by the combination of STS was lower than that of side effects induced by the administration without combined STS. Much larger doses of CDDP may be given ip by combining with STS.

[Reoperation of tetralogy of Fallot long after correction with aortic homograft: a case report]

Late results in the surgery for congenital heart disease repaired with external conduit have not yet been fully elucidated. We experienced a reoperation of tetralogy of Fallot (TF) that was previously repaired with an aortic homograft pretreated with beta-propiolactone for the reconstruction of right ventricular outflow tract. Ten years after correction of TF, right ventricular failure developed due to the regurgitation of tricuspid valve. At reoperation tricuspid annuloplasty was performed, and the valve of aortic homograft was also replaced with xenograft because of its uncertain durability. However, the resected valve had pliability with least degenerative change macroscopically. The postoperative course was smooth. The case was a rare one of late reoperation of TF due to the tricuspid valve regurgitation, and the case also indicated unexpected long durability of the valve cusp of the aortic homograft.

[Two-dimensional echocardiographic assessment of systemic-pulmonary shunts in infants with cyanotic heart disease]

The growth of pulmonary arteries following systemic-pulmonary arterial shunt procedures in infants with cyanotic heart disease is a determining factor to the prognoses of those patients. We assessed the validity of two-dimensional echocardiography (2DE) in evaluating pulmonary arterial growth following shunt procedures. Blood flow through the shunts was measured at the times of surgery, and the correlations between shunt flows and postoperative clinical courses were studied. 2DE was validated by its assessments of the right pulmonary artery (RPA) with an excellent correlation between the RPA diameter on 2DE and that on angiography (r = 0.97) and/or the actual RPA diameter measured at the times of surgery (r = 0.96) in 20 patients. Ten patients with tetralogy of Fallot and pulmonary atresia were studied by 2DE pre- and postoperatively. The RPA diameters of six patients with effective shunts increased from 5.7 +/- 1.7 mm to 8.5 +/- 1.5 mm during six months after the shunts and their left ventricular end-diastolic dimensions also increased significantly. But the RPA diameters in four patients with ineffective shunts did not show significant increases after the shunts. The shunt flows were correlated with the diameters of the anastomoses. The shunts which were obstructed within two years showed shunt flows of 83 +/- 26 ml/min, while the shunts which were patent for more than two years showed shunt flows of 320 +/- 126 ml/min. Serial measurements of RPA diameters by 2DE serve as a useful method of following patients after systemic-pulmonary shunts. The amounts of shunt flows were correlated with post-operative clinical courses over two year periods.

Indication of aortocoronary by-pass for coronary arterial obstruction due to Kawasaki disease

Six patients with coronary arterial lesions due to Kawasaki disease underwent aortocoronary by-pass grafting at our institute. Before surgery, all of them had been closely monitored for some years by means of selective coronary arteriography, thallium myocardial imaging, electrocardiography (treadmill and/or Holter), and two-dimensional echo cardiography. Based on this experience, we propose the following guidelines as an indication for aortocoronary by-pass in such patients. First, the following three conditions should be satisfied: 1) The progress of coronary arterial lesions has been documented by serial selective coronary arteriography; 2) redistribution to the perfusion defect has been detected on the delayed image in myocardial imaging; 3) no coronary arterial lesions distal to the graft site have been detected by coronary angiography. When these three conditions are satisfied, at least one of the following conditions must apply: 1) Localized stenosis in the left main trunk has progressed to critical stenosis; 2) there is occlusion of two or more vessels; 3) collateral vessels connecting to the peripheral portion of an occluded coronary artery arise from the peripheral part of a vessel with progressive localized stenosis; 4) progressive localized stenosis or critical stenosis has developed in the left anterior descending artery, in addition to significant stenosis in the right coronary artery.