[Analysis of Quality Management of in Vitro Diagnostic Reagent Clinical Trials]

Clinical trial is an important step of in vitro diagnostic reagents research and development. Based on the Guiding Principles and the key points of inspect on the spot, combined with the actual work experience, the article focuses on the prominent problems in the whole process of in vitro diagnostic reagent clinical trials. It is helpful to improve the level of hospital drug clinical trial centre and the quality of in vitro diagnostic reagent clinical trials by analyzing the issues.

New Vital Dye Injection Technique With Vitrectomy Probe

BACKGROUND AND OBJECTIVE

To evaluate a new, safer way to inject vital dye during chromovitrectomy for dye-assisted macular peeling.

PATIENTS AND METHODS

Prospective consecutive case series. Enrolled patients underwent macular surgery with a new technique of staining the epiretinal membrane and the internal limiting membrane with vital dyes. Twenty eyes of 20 patients (eight men, 12 women) were affected by idiopathic epiretinal membrane and underwent 25-gauge via pars plana vitrectomy for epiretinal membrane removal. Ten eyes were stained with Membrane Blue-Dual (Brilliant Blue G + trypan blue; DORC, Zuidland, The Netherlands) and 10 eyes were stained with Brilliant Peel (Brillant Blue G; Fluoron GmbH, Ulm, Germany). Preoperatively and postoperatively (1, 3, and 6 months) all patients received a complete ophthalmologic examination with best-corrected visual acuity (BCVA) assessment, swept-source optical coherence tomography, and multifocal electroretinography (mfERG).

RESULTS

The mean age of the patients was 67.0 years ± 8.6 years (range: 55 years to 78 years). No statistically significant difference in BCVA improvement or central foveal thickness decrease was observed in either group (P > .05). The mfERG showed an increase in electrical response densities 3 months after surgery.

CONCLUSION

The authors describe a new technique to inject vital dye during chromovitrectomy for dye-assisted macular peeling that may help to improve the overall safety of macular surgery. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:528-533.].

Circular stripes were more common in Barrett's esophagus after acetic acid staining

BACKGROUND

The diagnosis of Barrett's esophagus (BE) is disturbed by numerous factors, including correct gastroesophageal junction judgment, the initial location of the Z-line and the biopsy result above it. The acetic acid (AA) could help to diagnose BE better than high resolution imaging technology or magnifying endoscopy, by providing enhanced contrast of different epithelium. We have noticed AA could produce multiple white circular lines, forming circular stripes (CS), at lower esophagus, which hasn't been reported by others. This study aimed to investigate whether the CS is a special marker in BE patients.

METHODS

A total of 47 BE patients and 63 healthy people were enrolled from March 2016 to October 2016, and 2% AA staining had been operated routinely at lower esophagus under high resolution gastroscopy. We observed whether there were CS after AA staining and the images were compared between the two groups.

RESULTS

CS were confirmed in 42 patients (89.36%) in the BE group and 5 (7.94) in the control group ((χ2 = 72.931, P < 0.001)). The average width of CS was 0.76 ± 0.25 cm in BE group, which was similar to that in the control group (0.88 ± 0.11 cm). Villous or punctate or reticular pattern usually existed above or below the CS.

CONCLUSIONS

CS could be found at lower esophagus in most BE patients with AA staining, and this special feature might be valuable in diagnosing, evaluating and following up of BE patients.

Clinical sensitivity of HPV assays for the detection of high grade cervical disease in cervical samples treated with glacial acetic acid

BACKGROUND

Lysis of bloody liquid based cytology (LBC) specimens with glacial acetic acid (GAA) is performed to aid cytological interpretation. However, the influence of GAA treatment on HPV detection is not fully understood and in studies designed to assess this, few cases of high-grade disease have been included.

OBJECTIVES

To assess the sensitivity of HPV molecular tests for the detection of high grade cervical disease in GAA treated samples

STUDY DESIGN

A total of 207 specimens associated with high grade dyskaryosis and treated with GAA were collated prospectively. Overall 140 specimens had underlying CIN2+, including 88 CIN3. All specimens were tested with the Abbott RealTime High Risk HPV test (rtHPV) and the Qiagen Hybrid Capture 2High Risk HPV DNA test (HC2). Specimens associated with a CIN2+ that were negative by either assay were genotyped.

RESULTS

The sensitivity of rtHPV for CIN2+ and CIN3+ was 92.8% (87.2, 96.5) and 94.3% (87.2, 98.1) respectively. Sensitivity of the HC2 for CIN2+ and CIN3+ was 97.2% (92.8, 99.2) and 96.6% (90.3, 99.2) respectively. The sensitivity of both assays in GAA treated specimens was thus consistent with the level required for clinical application. HPV negative, CIN2+ specimens were generally attributable to HPV types outside the explicit analytical range of the assays.

CONCLUSIONS

The data indicate that GAA treatment has little impact on the detection of CIN2+ by HPV testing in LBC specimens.

Contrast-Induced Acute Kidney Injury: Comparison of Preventative Therapies

Contrast medium is used daily for diagnostic and interventional procdures as a means to visualize blood vessels. The administration of contrast dye, however, can lead to an acute reduction in kidney function. This complication can impact length of hospital stay, risk of dialysis, and increased hospital mortality. Common preventative measures include N-acetylcysteine and intravenous hydration. The evidence reviewed revealed hydration to be the more effective treatment to reduce the risk of acute kidney injury.

Evaluation of Provider Skills in Performing Visual Inspection with Acetic Acid in the Cervical Cancer Screening Program in the Meknes-Tafilalet Region of Morocco

BACKGROUND

This study documented the performance of providers of visual inspection with acetic acid (VIA) at primary health centers, assessing their compliance with the VIA skills checklist and determinants of non-compliance, and exploring their perceptions of VIA training sessions.

MATERIALS AND METHODS

A cross- sectional study was conducted among VIA providers in the Meknes-Tafilalet region of Morocco. Structured observation of their performance was conducted through supervisory visits and multiple focus group discussions (FGDs).

RESULTS

Performance of all the recommended steps for effective communication was observed in a low proportion of procedures (36.4%). Midwives/nurses had higher compliance than general practitioners (GPs) (p<0.001). All recommended steps for VIA examination were performed for a high proportion of procedures (82.5%). Compliance was higher among midwives/nurses than among GPs (p<0.001) and among providers in rural areas than those in urban areas (p<0.001). For pre-VIA counselling, all recommended steps were performed for only 36.8% of procedures. For post-VIA counseling, all recommended steps were performed in a high proportion (85.5% for VIA-negative and 85.1% for VIA-positive women). Midwives/nurses had higher compliance than GPs when advising VIA-positive women (p=0.009). All infection prevention practices were followed for only 14.2% of procedures, and compliance was higher among providers in rural areas than those in urban areas (p<0.001). Most FGD participants were satisfied with the content of VIA training sessions. However, they suggested periodic refresher training and supportive supervision.

CONCLUSIONS

Quality assurance of a cervical cancer screening program is a key element to ensure that the providers perform VIA correctly and confidently.

Hepatic insulin sensitivity in healthy and prediabetic subjects: from a dual- to a single-tracer oral minimal model

Recently, a model was proposed to assess hepatic insulin sensitivity during a meal, i.e., the ability of insulin to suppress glucose production (EGP), SI (P). The model was developed on EGP data obtained from a triple-tracer meal and the tracer-to-tracee clamp technique and validated against the euglycemic hyperinsulinemic clamp. The aim of this study was to assess whether SI (P) can be obtained from plasma concentrations measured after a single-tracer meal by incorporating the above EGP model into the oral glucose minimal model by describing both glucose production and disposal (OMM(PD)). Triple-tracer meal data of two databases (20 healthy and 60 healthy and prediabetic subjects) were used. Virtually model-independent EGP estimates were calculated. OMM(PD) was identified on exogenous and endogenous glucose concentrations, providing indices of SI (P), disposal insulin sensitivity (SI (D)), and EGP. The model fitted the data well, and SI (P) and SI (D) were estimated with precision in both databases (SI (P) = 5.48 ± 0.54 10(-4) dl·kg(-1)·min(-1) per μU/ml and SI (D) = 9.93 ± 2.18 10(-4) dl·kg(-1)·min(-1) per μU/ml in healthy; SI (P) = 5.41 ± 3.55 10(-4) dl·kg(-1)·min(-1) per μU/ml and SI (D) = 5.34 ± 6.17 10(-4) dl·kg(-1)·min(-1) per μU/ml, in healthy and prediabetic subjects). Estimated SI (P) and that derived from the triple-tracer EGP model were very similar on average. Moreover, the time course of EGP normalized to basal EGP (EGPb), and EGP/EGPb agreed with the results obtained using the triple-tracer method. In this study, we have demonstrated that SI (P), SI (D), and EGP/EGPb time course can be estimated reliably from a single-tracer meal protocol in both healthy and prediabetic subjects.

Efficacy of calcein and Coomassie Blue dyeing of shell growing-edges and micro growth-bands: ageing juvenile of Pinctada mazatlanica (Pterioida: Pteriidae)

Age validation is the first step to determine shellfish species age determination. This information is vital for different inferential models used in marine ecosystem management activities. In spite that various validation techniques are used for marking carbon calcium structures, the calcein marking technique for oysters had never been used for age validation in Pinctada mazatlanica. Thus the objectives of this study included: the evaluation of calcein to mark a shell growing-edge, and the efficacy of Coomassie Blue staining on posterior shell growth, to produce visible micro growth-bands that would enable age validation of juvenile mother-of-pearl oysters. Oysters were collected and cultivated at The Perlas del Cortez S. de R. L. MI. pearl-farming operation, in Pichilingue, La Paz Bay, Baja California Sur, Mexico; a total of 36 oysters (shell height 11.5-36.4 mm) were injected with calcein (0.125 g/L), and another 50 oysters (shell height 14.8-42.7 mm) were submersed in calcein (0.4 and 0.7 g/L). Shell slices of calcein-marked oysters were posteriourly stained with Coomassie Blue R-25 for micro growth-band recognition. Our results showed that Calcein marking only worked by submersion and produced a concise bright lime-green florescent band along the growing-edge with clear boundaries for both concentrations. However, marks resulted better at the lower calcein concentration (0.4 g/L) with more "perfect" and "good" marks on the growing-edge (p = 0.0012). Commassie Blue staining technique was successful, and allowed to conclude that one micro growth-band was laid down per day, similar to other oyster species. Mean 15-d increment of shell growth height was slightly greater at the lower calcein concentration (= 0.735 mm) than at the higher one (= 0.577 mm) (not significant difference, p = 0.198). Calcein marking of shell growing-edges and Commassie Blue staining of posterior shell growth, as a method for age validation is recommended for shellfish shell growth-band counts. This will allow back-dating for estimation of very precise colonization dates, both spatially and temporally in future work.

Miniature stick-packaging--an industrial technology for pre-storage and release of reagents in lab-on-a-chip systems

Stick-packaging of goods in tubular-shaped composite-foil pouches has become a popular technology for food and drug packaging. We miniaturized stick-packaging for use in lab-on-a-chip (LOAC) systems to pre-store and on-demand release the liquid and dry reagents in a volume range of 80-500 μl. An integrated frangible seal enables the pressure-controlled release of reagents and simplifies the layout of LOAC systems, thereby making the package a functional microfluidic release unit. The frangible seal is adjusted to defined burst pressures ranging from 20 to 140 kPa. The applied ultrasonic welding process allows the packaging of temperature sensitive reagents. Stick-packs have been successfully tested applying recovery tests (where 99% (STDV = 1%) of 250 μl pre-stored liquid is released), long-term storage tests (where there is loss of only <0.5% for simulated 2 years) and air transport simulation tests. The developed technology enables the storage of a combination of liquid and dry reagents. It is a scalable technology suitable for rapid prototyping and low-cost mass production.

Phloroglucinol inhibits the bioactivities of endothelial progenitor cells and suppresses tumor angiogenesis in LLC-tumor-bearing mice

BACKGROUND

There is increasing evidence that phloroglucinol, a compound from Ecklonia cava, induces the apoptosis of cancer cells, eventually suppressing tumor angiogenesis.

METHODOLOGY/PRINCIPAL FINDINGS

This is the first report on phloroglucinol's ability to potentially inhibit the functional bioactivities of endothelial progenitor cells (EPCs) and thereby attenuate tumor growth and angiogenesis in the Lewis lung carcinoma (LLC)-tumor-bearing mouse model. Although Phloroglucinol did not affect their cell toxicity, it specifically inhibited vascular endothelial growth factor (VEGF) dependent migration and capillary-like tube formation of EPCs. Our matrigel plug assay clearly indicated that orally injected phloroglucinol effectively disrupts VEGF-induced neovessel formation. Moreover, we demonstrated that when phloroglucinol is orally administered, it significantly inhibits tumor growth and angiogenesis as well as CD45(-)/CD34(+) progenitor mobilization into peripheral blood in vivo in the LLC-tumor-bearing mouse model.

CONCLUSIONS/SIGNIFICANCE

These results suggest a novel role for Phloroglucinol: Phloroglucinol might be a modulator of circulating EPC bioactivities, eventually suppressing tumorigenesis. Therefore, phloroglucinol might be a candidate compound for biosafe drugs that target tumor angiogenesis.

Stabilization of potassium permanganate particles with manganese dioxide

A new potassium permanganate reagent with slow-release properties was designed and tested for possible application in in situ chemical oxidation. For this purpose, MnO(2)-coated KMnO(4) particles (MCP) were prepared by partial reduction of solid KMnO(4) using the acid-catalyzed reaction with n-propanol or the comproportionation of Mn(VII) and Mn(II) in n-propanol as reaction medium. Column tests showed that, for MCP with a residual KMnO(4) fraction of 70wt%, the duration of permanganate release under flow-through conditions was prolonged by a factor of 10 compared to untreated KMnO(4). While KMnO(4) is too soluble to be used in reactive barriers, MCP could be introduced into the aquifer by filling of trenches or boreholes; this would allow a prolonged passive dosing of permanganate into the flowing groundwater. In addition, experiments were conducted in order to determine the oxidation capability of native KMnO(4) particles and MCP in CH(2)Cl(2), a representative non-polar non-aqueous phase liquid (NAPL). It may be possible to utilize the significantly higher reactivity of MCP under these conditions for the design of slow-release permanganate particles for NAPL source treatment.

Subchronic thyroid toxicity evaluation of 4,4'-methylenebis(N,N'-dimethyl)aniline in Fischer 344 rats

Female F344 rats were exposed to 4,4'-methylenebis(N,N'-dimethyl)aniline (MDA) by dietary feed at concentrations of 0, 50, 200, 375, 500, or 750 ppm for 5 d, 2 wk, 4 wk, and 13 wk duration. Endpoints evaluated included clinical observations, body weights, thyroid weights, serum thyroid hormones, blood MDA, gross pathology, and thyroid histopathology. There were no MDA exposure-related clinical signs of toxicity. Mean body weight decreased 5% compared to control in the 750 ppm group during study wk 6 through 13. Serum TSH increased and serum T4 and T3 levels decreased with increasing feed concentrations of MDA and time of exposure. Thyroid weight increases were both concentration- and exposure time-dependent and statistically significant at ≥375 ppm. Incidence and severity of decreased colloid, follicular cell hypertrophy and follicular cell hyperplasia were also related to MDA concentration and exposure time. A no-observed-adverse-effect level (NOAEL) of 200 ppm was selected based on the statistically significant increase in incidence of follicular cell hyperplasia at concentrations ≥375 ppm.

Comparative study of RT23 and Merieux tuberculin tested among healthy volunteers

SETTING

Several studies have indicated considerable variability in the biological results of different tuberculin preparations in different geographical areas or even within a single region.

OBJECTIVE

To compare the biological potency of two different tuberculins.

DESIGN

We performed simultaneous testing with RT23 and Merieux tuberculin in a group of 546 Police Academy students in Athens to compare reactions to both tuberculins. The students were divided into three groups according to their year of training; the participants in each group were tested using the Mantoux method simultaneously with the two tuberculins in different concentrations.

RESULTS

Using a 10 mm cut-off point for a positive tuberculin skin test, positive reactions to RT23 and Merieux were highly correlated. No statistically significant difference was established. The results indicated significant superiority of the size of the reaction with RT23 tuberculin (P = 0.014).

CONCLUSIONS

Both tuberculins appear to have equivalent potency, with RT23 more frequently producing reactions of larger sizes.

One-step chromoendoscopy and structure enhancement using balsamic vinegar for screening of Barrett's esophagus

BACKGROUND AND STUDY AIMS

Screening for specialized columnar epithelium (SCE) within columnar lined esophagus (CLE) with standard video endoscopes is not reliable enough. Several methods to improve accuracy of predicting presence of SCE like chromoendoscopy with vital stains or structure enhancement with acetic acid have been introduced but data up to now remains controversial. The present prospective study was conducted to evaluate a combination of chromoendoscopy and acetic acid structure enhancement using the naturally brownish coloured balsamic vinegar during routine upper endoscopy.

PATIENTS AND METHODS

Between March and July 2006 20 patients with macroscopic suspicion for SCE during routine endoscopy were included prospectively. Saline diluted balsamic vinegar (3%) was administered with a spraying catheter at the distal esophagus. After 1 minute the distal esophagus was evaluated for the presence of SCE according to the mucosal surface pattern (pattern I-II: round pits/circular pattern predicting gastric epithelium; pattern III-IV: ridged/villous pattern predicting Barrett's epithelium). Only HR-videoendoscopes without magnification were used. After presence or absence of SCE was defined by the endoscopist targeted biopsies of the CLE were performed. Histological results were compared with endoscopic findings.

RESULTS

In 9 of 20 patients (13 male, 7 female; mean age 60.0 +/- 12.8 years) biopsy specimen revealed SCE within CLE on histology. Prediction of BM after balsamic vinegar staining was possible in all cases. Surface pattern I-II was found in 9 patients and pattern III-IV in 11 patients. Accuracy, sensitivity and specificity for BV staining predicting SCE were 90%, 100% and 82%, respectively.

CONCLUSION

Chromoendoscopy with balsamic vinegar combines the advantages of chromoendoscopy and structure enhancement by acetic acid for detection of SCE. The reliability in predicting the presence of SCE was high in this prospective feasibility study.

Vulvoscopy: review of a diagnostic approach requiring clarification

The objective of this review is to clarify what, if any, role there is for colorimetric (acetic acid and toluidine blue) testing and colposcopic examination of the vulva by reviewing the literature regarding use of the colposcope and colorimetric tests in the diagnosis of vulvar disorders. The lack of established usefulness of colposcopic observation for common dermatologic entities affecting the vulva markedly reduces the need for the colposcopist's skills in dealing with disorders of the vulva. Conversely, vulvar, as opposed to cervical, disorders place more emphasis on a gynecologist's knowledge and experience with dermatologic disease. The use of the colposcope and acetic acid, toluidine blue or both adds little or nothing to "naked-eye" examination of the vulva. The term vulvoscopy is appropriate and useful because it is easy to comprehend. However, vulvoscopy should be defined as a composite diagnostic act composed of careful naked-eye and low-power magnified examination carried out by those with interdisciplinary skills, such as vulvologists.

Salvage cryosurgical ablation of the prostate for local recurrence after radiation therapy: improved outcomes utilizing a capromab pendetide scan and biopsy algorithm

PURPOSE

We assessed the efficacy, complications and technical advancements in salvage cryosurgical ablation of the prostate for recurrent prostate cancer after radiation therapy.

METHODS

A total of 58 patients were evaluated for salvage cryosurgery using an algorithm of capromab pendetide scan and prostate biopsy from January 2003-July 2007. Forty-seven patients underwent salvage cryosurgery and biochemical recurrence free survival and complications were retrospectively reviewed. Mean follow-up was 24 months.

RESULTS

Seventy percent of patients achieved a nadir PSA < 0.5 ng/ml. Overall, 51% of patients achieved a durable PSA response with a pre-salvage serum PSA < 10 predictive of success. There were no major complications and minor complications were few.

CONCLUSION

Salvage cryotherapy in experienced hands utilizing third-generation technology provides for excellent biochemical control with minimal morbidity.

Flow characterization of a microfluidic device to selectively and reliably apply reagents to a cellular network

A three-dimensional microfluidic device has been successfully fabricated and the flow streams characterized for eventual use in studying communication in an in vitro network of nerve cells. The microfluidic system is composed of two layers of channels: a lower layer for the delivery of pharmacological solutions and an upper layer of channels used to direct the flow of the pharmacological solution streams and perfuse the cells with media and nutrients. Flow profiles have been characterized with computational fluid dynamics simulations, confocal fluorescence microscopy, and carbon-fiber amperometry, which have been used to map changes in flow profiles at different bulk flow rates. Ultimately, the microfluidic system and incorporated cell network will show how networked neurons adapt, compensate, and recover after being exposed to different chemical compounds.

Evaluation of Enhanced Peritoneum Permeability in Methylglyoxal-treated Rats as a Diagnostic Method for Peritoneal Damage

PURPOSE

As peritoneal damage in long-term peritoneal dialysis therapy is a major problem correlated to patient prognosis, diagnosis of peritoneal damage is important. To develop a diagnostic method for peritoneal damage, we focused on hyperpermeability across the peritoneum in a pathogenic peritoneal damage condition. In this study, disposition characteristics of an intraperitoneally injected marker substance in peritoneal damaged rats were analyzed.

MATERIALS AND METHODS

Peritoneal damaged rats were prepared by intraperitoneal injection of a glucose degradation product, methylglyoxal (MGO), for five or ten consecutive days. Phenolsulfonphthalein (PSP), as a marker substance, was intraperitoneally or intravenously injected into MGO-treated rats. Subsequently, the PSP disposition characteristics were pharmacokinetically analyzed.

RESULTS

In both cases of 5 and 10 days treatment of MGO, absorption of PSP after intraperitoneal injection was significantly enhanced. Plasma concentration and urinary excretion of PSP in MGO-treated rats were also higher than those in saline-treated rats in the early phase. On the contrary, there was no significant difference in terms of the pharmacokinetic parameters of intravenously injected PSP in saline- or MGO-treated rats. These results indicated that intraperitoneally injected MGO primarily acts on the peritoneal membrane; therefore, the peritoneal permeability of the marker substance was enhanced.

CONCLUSION

We demonstrated that pharmacokinetic analysis of peritoneum permeability might be a potent diagnostic method for peritoneal damage in experimental animals and patients receiving peritoneal dialysis.

Topical vaginal oestrogen cream used for treatment of burn injury of vaginal mucosa after misapplication of 100% acetic acid in a perimenopausal woman: a case report

BACKGROUND

Three to five per cent acetic acid is commonly used in the field of gynaecology for colposcopic examinations of the cervix. It gives an 'acetowhite' effect that may assist clinicians in identifying neoplastic areas.

CASE

A perimenopausal woman was treated with acetic acid for abnormal Pap smear report (cervical intraepithelial neoplasia 1). During application, the patient complained of burning sensation of vagina and vulva. The vagina was saline-irrigated after realising that the acetic acid had not been diluted. Following this incident, the patient was seen weekly and treated with conjugated vaginal oestrogen cream. The patient recovered and the vagina mucosa healed within two weeks.

CONCLUSION

Acetic acid is corrosive and may cause vagina bleeding. Oestrogen cream can be used in an attempt to minimise the adverse reaction and speed the healing process.

Comparison of computed virtual chromoendoscopy and conventional chromoendoscopy with acetic acid for detection of neoplasia in Barrett's esophagus

BACKGROUND AND STUDY AIMS

Computed virtual chromoendoscopy (CVC) is a new imaging technique that enhances mucosal surface contrast and highlights the vascular pattern without the need for dye-spraying as in conventional chromoendoscopy. The aim of this prospective randomized pilot study with a crossover design was to compare CVC with conventional chromoendoscopy with acetic acid (CAA) for the detection of high grade intraepithelial neoplasia (HGIN) or early cancer in patients with Barrett's esophagus.

PATIENTS AND METHODS

57 patients with Barrett's esophagus (mean length 3.8 cm) and a history of HGIN/early cancer or suspected HGIN/early cancer were randomly allocated to undergo either CAA or CVC. All patients were re-examined with the alternative procedure at 4 - 6 weeks after the initial endoscopy. The two procedures were performed by five endoscopists, who were blinded to the findings of the other examination. At each examination, targeted biopsies were taken from all detected lesions, followed by random four-quadrant biopsies.

RESULTS

In 24/57 patients, 30 lesions with HGIN/early cancer were detected. The sensitivity of targeted biopsies for HGIN/early cancer on a 'per lesion' basis was 87 % (26/30) for both CAA and CVC. The positive predictive value was 39 % (26/66) for CAA and 37 % (26/70) for CVC. In the 'per patient' analysis, sensitivity was 83 % (20/24) and 92 % (22/24) for CAA and CVC, respectively ( P = 0.617). Stepwise random four-quadrant biopsies identified only one patient with HGIN/early cancer that was missed by both, CAA and CVC.

CONCLUSIONS

Computed virtual chromoendoscopy is a helpful adjunct for surveillance of Barrett's esophagus and appears to be as accurate as conventional chromoendoscopy in the detection of HGIN/early cancer.

Marker retention in the cochlea following injections through the round window membrane

Local delivery of drugs to the inner ear is increasingly being used in both clinical and experimental studies. Although direct injection of drugs into perilymph appears to be the most promising way of administering drugs quantitatively, no studies have yet demonstrated the pharmacokinetics in perilymph following direct injections. In this study, we have investigated the retention of substance in perilymph following a single injection into the basal turn of scala tympani (ST). The substance injected was a marker, trimethylphenylammonium (TMPA) that can be detected in low concentrations with ion-selective microelectrodes. Perilymph pharmacokinetics of TMPA was assessed using sequential apical sampling to obtain perilymph for analysis. The amount of TMPA retained in perilymph was compared for different injection and sampling protocols. TMPA concentrations measured in fluid samples were close to those predicted by simulations when the injection pipette was sealed into the bony wall of ST but were systematically lower when the injection pipette was inserted through the round window membrane (RWM). In the latter condition, it was estimated that over 60% of the injected TMPA was lost due to leakage of perilymph around the injection pipette at a rate estimated to be 0.09muL/min. The effects of leakage during and after injections through the RWM were dramatically reduced when the round window niche was filled with 1% sodium hyaluronate gel before penetrating the RWM with the injection pipette. The findings demonstrate that in order to perform quantitative drug injections into perilymph, even small rates of fluid leakage at the injection site must be controlled.

A novel technique for localization of small pulmonary nodules

BACKGROUND

To show the safety and accuracy of a new marking technique using an image-guided technique for preoperative localization of a small pulmonary nodule.

METHODS

CT data of a patient with a peripheral pulmonary nodule < 20 mm were transmitted to a surgical navigation system (StealthStation Treon Treatment Guidance System; Medtronic; Louisville, KY). To match preoperative CT image data to the physical space occupied by the patient during surgery, five to six superficial skin fiducials were used for registration. A 16-gauge needle attached by a positioning sensor was advanced into or immediately adjacent to the nodule for injection of methylene blue under guidance of the StealthStation system. Then the lesion marked by the methylene was thoracoscopically resected.

RESULTS

Seventeen patients (12 men and 5 women; mean age, 51.3 years) underwent this procedure, and all the nodules were identified due to the precise location of the probe. They were resected with sufficient margins. There were no surgical complications. The average time of registration was 4.8 +/- 0.9 min (+/- SD). Registration error was on average 2.7 +/- 0.2 mm.

CONCLUSIONS

Image-guided navigation is useful, accurate, and safe in the localization of small peripheral lung lesions.

The organization of frontoparietal cortex in the tree shrew (Tupaia belangeri): II. Connectional evidence for a frontal-posterior parietal network

Tree shrews are small squirrel-like mammals that are the closest living relative to primates available for detailed neurobiological study. In a recent study (Remple et al. [2006] J. Comp. Neurol. 497:133-154), we provided anatomical and electrophysiological evidence that the frontoparietal cortex of tree shrews has two motor fields (M1 and M2) and five somatosensory fields (3a, 3b, S2, somatosensory caudal area [SC], and parietal ventral area [PV]). In the present study, we injected anatomical tracers into M1, M2, 3a, 3b, SC, and posterior parietal cortex to establish the ipsilateral cortical connections of these areas. The results provide evidence for a number of new cortical areas including medial motor and somatosensory areas (MMA and MSA), three posterior parietal areas (PPd, PPv, and PPc), and an area ventral to temporal inferior cortex (TIV). Ml receives topographic projections from M2, MMA, 3a, and PPv, and nontopographic connections from the temporal anterior and dorsal areas (TA and TD), PPc, TIV, and MSA. The connections of M2 are similar to those of M1, except that M2 receives denser projections from TIV, PPc, and dorsal frontal cortex and sparser input from M1. Areas 3a, 3b, and SC receive dense topographic projections from each other, S2, and PV and sparser connections from PPd and PPv. Area 3a receives additional input from posterior parietal and temporal regions and from M1 and MMA. Overall, the frontoparietal connections of tree shrew cortex are most similar to those of prosimian primates and quite different from those of more distant relatives such as rats.

Comparison of four different intra-articular injection sites in the knee: a cadaver study

Although intra-articular knee injection is not a complicated procedure, it could be difficult to assess whether the tip of the needle lies free in the joint or is embedded in synovium or other intra-articular soft tissues. The purpose of this study was to evaluate the accuracy rate of intra-articular injection using anteromedial (AM), anterolateral (AL), lateral midpatellar (LMP), and medial midpatellar (MMP) portals in cadavers. In this study 156 knees of 78 fresh cadavers were included. Anterolateral and AM injection to both knees of 39 cadavers (78 knees) were performed. MMP and LMP injection to both knees of other 39 cadavers were also performed. Accuracy rate was the highest (85%) in the AL injection portal and lowest in the MMP portal (56%). In conclusion, the accuracy obtained with use of the MMP portal was significantly lower than that obtained with the use of either the AM (P < 0.05), AL (P < 0.0001), or LMP (P < 0.05) portal. Although AL injection site resulted in good intra-articular delivery with 85% accuracy rate and with a lower incidence of soft tissue infiltration, the results were not statistically significant when compared to AM and LMP portals. Therefore, any of these three portals might be preferred depending on the experience of the physician. On the other hand, 100% accuracy could not be obtained through any portals in the study, which should be kept in mind when treating knee problems with intra-articular medications.

On the use of retrograde tracers for identification of axon collaterals with multiple fluorescent retrograde tracers

A common method for identifying collateral projections is to inject different retrograde tracers into two targets and examine labeled cells for the presence of both tracers. Double-labeled cells are considered to have collateral projections to the two injection sites. This method is widely considered to underestimate the extent of collaterals. To test the efficiency of double-labeling, we mixed equal volumes of two tracers, injected them into one site in a guinea-pig brain, and counted the resulting labeled cells. Ideally, the tracers would have precisely overlapping injection sites and all labeled cells would contain both tracers. We tested several combinations of tracers: 1) Fast Blue and fluorescein dextran; 2) fluorescein dextran and FluoroGold; 3) fluorescein dextran and FluoroRuby; 4) FluoroGold and green beads; 5) FluoroGold and red beads; 6) FluoroRuby and green beads; and, 7) green beads and red beads. For each combination, a mixture was injected into the left inferior colliculus. After 1 week to allow for transport, labeled cells were counted in the right inferior colliculus and the left temporal cortex. For each mixture, the results were similar for the two areas. The percentage of cells that were double-labeled varied from 0% to 100%, depending on tracer combination. The highest efficiencies (>96%) were observed with red beads and green beads or with FluoroRuby and fluorescein dextran. The limited efficiency of other mixtures could be accounted for only in part by incomplete overlap of the two tracers at the injection site. The results indicate that the specific combination of tracers used to search for collateral projections can greatly affect the findings.

Estimation of hepatic distributional volumes using non-labeled reference markers

Hepatic distributional volumes were investigated in the in situ perfused rat liver. Perfusion experiments were conducted using Krebs bicarbonate buffer delivered via the portal vein in single-pass mode at a total flow rate of 15 mL/min. A bolus dose of normal erythrocytes (RBC, vascular marker) and Evans blue (EB, extracellular marker) respectively was administered in the presence and absence of protein. At the end of the experiment, liver total water content was determined by desiccation and freeze-drying methods. Similar moment analysis results and superimposable effluent curves were obtained in the presence (RBC, mean transit time [MTT]: 7.31 +/- 0.45 s and volume of distribution [V]: 0.17 +/- 0.01 mL/g; EB, MTT: 10.9 +/- 0.62 s and V: 0.25 +/- 0.02 mL/g) and in the absence (RBC, MTT: 7.55 +/- 0.84 s and V: 0.18 +/- 0.02 mL/g; EB, MTT: 9.24 +/- 0.77 s and V: 0.20 +/- 0.02 mL/g) of protein, which indicates that the hepatic distribution of RBC and EB within the liver is not influenced by protein. Furthermore, the almost identical results obtained with the desiccation and freeze-drying methods clearly suggest that the freeze-drying method can be used as an alternative to desiccation for the estimation of liver water content.

The use of acetic acid in magnification chromocolonoscopy for pit pattern analysis of small polyps

BACKGROUND AND STUDY AIMS

The role of acetic acid spray during magnification chromocolonoscopy has not previously been evaluated. We aimed to compare the accuracy of predicting polyp histology at magnification colonoscopy, using acetic acid and indigo carmine, either alone or in combination.

PATIENTS AND METHODS

A total of 46 consecutive patients with polyps detected during colonoscopy which measured 10 mm or less were alternately divided into two groups. In group A patients, 1.5 % acetic acid was applied to the mucosa first, followed by indigo carmine spray; in group B patients, the order was reversed. The pit pattern was assessed after application, in real time. All the lesions were resected and examined histologically.

RESULTS

Altogether, 37 adenomas and 36 hyperplastic polyps were evaluated. In group A, the diagnostic accuracy after spraying with acetic acid was 95 %, which increased to 98 % after application of indigo carmine. In group B, the accuracy after indigo carmine application was 83 %. After subsequent spraying with acetic acid, images were enhanced in 70 % of patients, with an increase in accuracy to 97 %. The mean time required to obtain an initial clear image with the first dye was 14 seconds for both groups.

CONCLUSIONS

This is the first description of the use of acetic acid for pit pattern analysis of colonic polyps. Its ease of use, low cost, and safety, together with its excellent accuracy in the assessment of polyp pit patterns suggest that this method could easily be applied to routine magnification colonoscopy.

[Effect of different cooking treatments of Mucuna beans on its L-Dopa content]

The main limiting factor in the consumption by humans of the velvet bean (Mucuna) is its relatively high content of L-Dihydroxyphenylalanine (L-Dopa), with levels as high as 9%. Conventional cooking methods used to transform raw velvet bean into an edible product are not sufficiently effective in reducing the levels of L-Dopa in adequate processing time. In this report, Mucuna beans were cooked by microwave, utilizing vapor and in water solutions at pH 3, 6, 7, 9 and 11. Cooking alkaline solutions were achieved using sodium hydroxide, potassium hydroxide, and calcium hydroxide. The acid pH was achieved through the use of HCl. The initial cooking time was fixed at 6 hrs. The processed bean samples were dried, ground and analyzed for L-Dopa and protein. The ground samples were further washed with boiling water for 0, 3 and 6 minutes, them dried and analyzed. None of the procedures evaluated was capable of eliminating L-Dopa from Mucuna beans. The Ca(OH)2 treatment at pH 9 which was washed with hot water produce a reduction of L-Dopa of 80.4%. There was not effect attributed to the alkaline ions. Reducing particle size appears to be most effective as it has been shown by other workers.

Bromophenol blue staining of tumors in a rat glioma model

OBJECTIVE

For patients with gliomas, decreasing the tumor burden with macroscopic surgical resection may affect quality of life, time to tumor progression, and survival. Injection of bromophenol blue (BPB) may enhance intraoperative visualization of an infiltrating tumor and its margins and improve the extent of resection. In this study, we investigated the uptake of BPB in experimental rat brain tumors.

METHODS

We first conducted a toxicity study with bolus intravenous injections of 5, 60, and 360 mg/kg doses of BPB in nontumor-bearing Fischer 344 rats. No adverse effects were observed in any of the animals during the 60 day observation period. We then injected 9L tumor cells intracerebrally into Fischer 344 rats and approximately 2 weeks later, administered a bolus intravenous injection of 5 to 360 mg/kg BPB. Fifteen minutes after BPB injection, we sacrificed the animals and removed their brains. In a subsequent study, we injected 180 mg/kg BPB and sacrificed animals at several time points to monitor tumor staining over time.

RESULTS

The stain was clearly visible and localized to the tumor for all BPB concentrations 60 mg/kg or greater, and in an additional experiment, we found that tumor staining persisted for at least 8 hours after BPB injection.

CONCLUSION

We conclude that BPB helped visualize experimental tumors at time points from a few minutes to several hours after injection. Because BPB also proved to be nontoxic to the animals at effective concentrations, we believe the compound may be potentially useful in helping neurosurgeons visualize brain tumors in humans.

Complete regression of experimental prostate cancer in nude mice by repeated hyperthermia using magnetite cationic liposomes and a newly developed solenoid containing a ferrite core

BACKGROUND

Magnetite cationic liposomes (MCLs) can be used to induce hyperthermia because they generate heat in an alternating magnetic field (AMF). This study aimed at developing more practical method for MCL hyperthermia examining the effect of MCL-induced hyperthermia on human prostate cancer in vivo.

MATERIALS AND METHODS

A newly developed AMF generator incorporating a solenoid with a ferrite core (FC) was used. Human prostate cancer cells (PC-3 and LNCap) were injected subcutaneously into nude mice. MCLs were injected into tumor nodule and the mice were exposed into AMF three times at 24-hr intervals (repeated hyperthermia; RH) until complete tumor regression was observed.

RESULTS

Irradiation with an AMF generated by newly developed device can adequately increase the temperature of tumor tissue. Frequent RH resulted in complete tumor regression in all nude mice.

CONCLUSION

RH using MCLs may be a promising new therapy for hormone-refractory human prostate cancer in the future.

Graft loss due to percutaneous sclerotherapy of a lymphocele using acetic acid after renal transplantation

Development of lymphoceles after renal transplantation is a well-described complication that occurs in up to 40% of recipients. The gold standard approach for the treatment of symptomatic cases is not well defined yet. Management options include simple aspiration, marsupialization by a laparotomy or laparoscopy, and percutaneous sclerotherapy using different chemical agents. Those approaches can be associated, and they depend on type, dimension, and localization of the lymphocele. Percutaneous sclerotherapy is considered to be less invasive than the surgical approach; it can be used safely and effectively, with low morbidity, in huge, rapidly accumulating lymphoceles. Moreover, this approach is highly successful, and the complication rate is acceptable; the major drawback is a recurrence rate close to 20%. We herewith report a renal transplant case in which the patient developed a symptomatic lymphocele that was initially treated by ultrasound-guided percutaneous sclerotherapy with ethanol and thereafter using acetic acid for early recurrence. A few hours after injection of acetic acid in the lymphatic cavity, the patient started to complain of acute pain localized to the renal graft and fever. An ultrasound of the abdomen revealed thrombosis of the renal vein and artery. The patient was immediately taken to the operating room, where the diagnosis of vascular thrombosis was confirmed and the graft was urgently explanted. In conclusion, we strongly suggest avoiding the use of acetic acid as a slerosating agent for the percutaneous treatment of post-renal transplant lymphocele because, based on our experience, it could be complicated by vascular thrombosis of the kidney, ending in graft loss.

Intravenous polyethylene glycol inhibits the loss of cerebral cells after brain injury

We have tested the effectiveness of polyethylene glycol (PEG) to restore the integrity of neuronal membranes after mechanical damage secondary to severe traumatic brain injury (TBI) produced by a standardized head injury model in rats. We provide additional detail on the standardization of this model, particularly the use and storage of foam bedding that serves to both support the animal during the impact procedure-and as a dampener to the acceleration of the brass weight. Further, we employed a dye exclusion technique using ethidium bromide (EB; quantitative evaluation) and horseradish peroxidase (HRP; qualitative evaluation). Both have been successfully used previously to evaluate neural injury in the spinal cord since they enter cells when their plasma membranes are damaged. We quantified EB labeling (90 microM in 110 microL of sterile saline) after injection into the left lateral ventricle of the rat brain 2 h after injury. At six h after injection and 8 h after injury, the animals were sacrificed and the brains were analyzed. In the injured rat brain, EB entered cells lining and medial to the ventricles, particularly the axons of the corpus callosum. There was minimal EB labeling in uninjured control brains, limited to cells lining the luminal surfaces of the ventricles. Intravenous injections of PEG (1 cc of saline, 30% by volume, 2000 MW) immediately after severe TBI resulted in significantly decreased EB uptake compared with injured control animals. A similar result was achieved using the larger marker, HRP. PEG-treated brains closely resembled those of uninjured animals.

Enhancing effects of simultaneous treatment with sodium nitrite on 2-amino-3-methylimidazo[4,5-f]quinoline-induced rat liver, colon and Zymbal's gland carcinogenesis after initiation with diethylnitrosamine and 1,2-dimethylhydrazine

Combined effects of sodium nitrite (NaNO2) and 2-amino-3-methylimidazo[4,5-f]quinoline (IQ) on liver, colon and Zymbal's gland carcinogenesis were assessed using a rat two-stage carcinogenesis model, with a focus on involvement of oxidative stress. Male 6-week-old F344 rats were given a single intraperitoneal injection of 200 mg/kg of diethylnitrosamine and 4 subcutaneous injections of 40 mg/kg of 1,2-dimethylhydrazine for initiation. Then, they were administered 0 or 300 ppm IQ in the diet or 0, 0.1 or 0.2% NaNO2 in their drinking water for 27 weeks. The treatment with NaNO2+IQ significantly enhanced colon and Zymbal's gland carcinogenesis and tended to enhance hepatocarcinogenesis. The incidence of lung tumors in the IQ-treated groups was significantly increased as compared with the initiation alone group. In a second experiment, male rats were given IQ or NaNO2 under the same conditions as before for 1 week, and at sacrifice, their liver and colon tissue or mucosa were collected for analysis of 8-hydroxydeoxyguanosine (8-OHdG), thiobarbituric acid reactive substances (TBARS), acrolein-modified protein and the bromodeoxyuridine-labeling index (BrdU-LI) (in the colon). In the colon, 8-OHdG, acrolein-modified protein levels and BrdU-LI were significantly increased by the combined treatment. These results indicate that the treatment with NaNO2 enhances IQ-induced colon and Zymbal's gland carcinogenesis in rats and that oxidative DNA damage and lipid peroxidation may partly be involved, especially in the colon. In addition, this experiment showed that IQ can act as a potent lung carcinogen in rats.

Differential expression of endothelin-2 along the mouse intestinal tract

Endothelin (ET)-2, an ET family peptide, is highly expressed in intestine. However, the specific distribution and function of ET-2 remain unknown. We elucidated the expression profile and localization of ET-2 in mouse gastrointestinal tract. Real-time PCR analysis revealed that ET-2 gene expression in the gastrointestinal tract of healthy animals was relatively high in the colon. Immunohistochemical analysis revealed ET-2-like immunoreactivity mainly in epithelial cells of the mucosa throughout the intestinal tract of healthy animals. Intracellularly, ET-2 was concentrated close to the basement membrane of intestinal epithelial cells. A weak ET-2-like immunoreactivity was also localized to some neurofibers and the myenteric plexus of the muscle layer, coexpressing with vasoactive intestinal peptide. ET-2-like immunoreactivity was also detected at Brunner's glands of the duodenum and follicle-associated epithelium of Peyer's patch. In contrast, ET-1-like immunoreactivity was uniformly distributed in epithelial cells. In dextran sulfate sodium (DSS)-induced colitis, colonic ET-2 was upregulated during the late stage of DSS treatment. These results suggest that in intestinal epithelial cells ET-2 could be secreted into the lamina propria and the dome region in Peyer's patch, and that it might modulate immune cells in these sites for mucosal defense.

Direct autoradiographic evidence that rebamipide interacts with neutrophils in dextran sulfate sodium induced colitis in rats

To determine the effects of rebamipide during the early stages of colitits development, colitis was induced in rats by oral administration of dextran sulfate sodium for 3 or 7 days. The target sites of (3)H-rebamipide were examined by intra-aortic infusion of the radiolabeled compound followed by autoradiography. (3)H-rebamipide was localized in goblet cells in the colon of the control rat, whereas it accumulated in the cytoplasm of mesenchymal cells in dextran sulfate sodium treated rats, localized predominantly to polymorphonuclear leucocytes.

Radiofrequency Thermal Ablation: Increase in Lesion Diameter with Continuous Acetic Acid Infusion

PURPOSE

To evaluate the influence of continuous infusion of acetic acid 50% during radiofrequency ablation (RFA) on the size of the thermal lesion produced.

METHODS

Radiofrequency (RF) was applied to excised bovine liver by using an expandable needle electrode with 10 retractable tines (LeVeen Needle Electrode, RadioTherapeutics, Sunnyvale, CA) connected to a commercially available RF generator (RF 2000, RadioTherapeutics, Sunnyvale, CA). Experiments were performed using three different treatment modalities: RF only (n = 15), RF with continuous saline 0.9% infusion (n = 15), and RF with continuous acetic acid 50% infusion (n = 15). RF duration, power output, tissue impedance, and time to a rapid rise in impedance were recorded. The ablated lesions were evaluated both macroscopically and histologically.

RESULTS

The ablated lesions appeared as spherical or ellipsoid, well-demarcated pale areas with a surrounding brown rim with both RF only and RF plus saline 0.9% infusion. In contrast, thermolesions generated with RF in combination with acetic acid 50% infusion were irregular in shape and the central portion was jelly-like. Mean diameter of the coagulation necrosis was 22.3 +/- 2.1 mm (RF only), 29.2 +/- 4.8 mm (RF + saline 0.9%) and 30.7 +/- 5.7 mm (RF + acetic acid 50%), with a significant increase in the RF plus saline 0.9% and RF plus acetic acid 50% groups compared with RF alone. Time to a rapid rise in impedance was significantly prolonged in the RF plus saline 0.9% and RF plus acetic acid 50% groups compared with RF alone.

CONCLUSIONS

A combination of RF plus acetic acid 50% infusion is able to generate larger thermolesions than RF only or RF combined with saline 0.9% infusion.

Chemically inactivated adenoviral vectors that can efficiently transduce target cells when delivered in the form of virus-microbead conjugates

Safe and effective use of viral vectors for gene therapeutics requires versatile control over their delivery to target sites in human subjects. We have developed a strategy for the creation of adenoviral vectors that possess conditional infectivity. The adenoviral vectors used were inactivated chemically such that they had little or no ability to infect cells. However, when such chemically inactivated adenoviral vectors were conjugated to the surfaces of appropriate microbeads and the resulting adenovirus-microbead conjugates were provided with the ability to associate stably with cells, the infectivity of these adenoviral vectors was restored. For certain target cell lines, the infectivity of such adenovirus-microbead conjugates became even higher than that of free, unmodified adenoviral vectors. As a result of the chemical inactivation of viral infectivity, any adenoviral particles that become free from the microbeads should be noninfectious. Thus, these adenoviral vectors have an infectivity that is conditional: They can only infect cells, to which their microbead conjugates come into stable contact. These results lay the groundwork for the creation of targetable adenovirus-microbead conjugates with greater efficacy and safety as delivery agents for gene therapeutics.

A modified Trastuzumab antibody for the immunohistochemical detection of HER-2 overexpression in breast cancer

The immunohistochemical determination of HER-2 to identify patients with advanced breast cancer candidates for Trastuzumab treatment proved neither accurate nor fully reliable, possibly because none of the current reagents detects the specific antigenic site target of Trastuzumab. To circumvent this problem, we conjugated the NH₂ groups of Trastuzumab with biotin, and the compound obtained, designated BiotHER, was added directly to tissue sections. Biotin-labelling was revealed with horseradish peroxidase-conjugated streptavidin. Specificity and sensitivity of BiotHER immunostaining with respect to HER-2 amplification were tested on 164 breast carcinoma samples. BiotHER staining was detected on the tumour cell membrane of 12% of all specimens and in 49% specimens with gene amplification, while absent in nonamplified tumours. Predictivity of BiotHER status with respect to the clinical outcome was analysed in 54 patients with HER-2 amplified advanced breast cancer treated with Trastuzumab plus chemotherapy. BiotHER staining, detected in 50% of tumours with HER-2 amplification, was an independent predictor of clinical outcome. In fact, BiotHER positivity was independently associated with increased likelihood of tumour response and reduced risk of tumour progression and death. Biotinylated Trastuzumab can thus be used for immunohistochemical detection of HER-2 overexpression in breast cancer, and has the potential to identify patients likely to benefit from Trastuzumab treatment.

Toll-like receptor 9-induced type I IFN protects mice from experimental colitis

Experimental colitis is mediated by inflammatory or dysregulated immune responses to microbial factors of the gastrointestinal tract. In this study we observed that administration of Toll-like receptor 9 (TLR9) agonists suppressed the severity of experimental colitis in RAG1-/- but not in SCID mice. This differential responsiveness between phenotypically similar but genetically distinct animals was related to a partial blockade in TLR9 signaling and defective production of type I IFN (i.e., IFN-alpha/beta) in SCID mice upon TLR9 stimulation. The addition of neutralization antibodies against type I IFN abolished the antiinflammatory effects induced by TLR9 agonists, whereas the administration of recombinant IFN-beta mimicked the antiinflammatory effects induced by TLR9 agonists in this model. Furthermore, mice deficient in the IFN-alpha/beta receptor exhibited more severe colitis than wild-type mice did upon induction of experimental colitis. These results indicate that TLR9-triggered type I IFN has antiinflammatory functions in colitis. They also underscore the important protective role of type I IFN in intestinal homeostasis and suggest that strategies to modulate innate immunity may be of therapeutic value for the treatment of intestinal inflammatory conditions.

Apolipoprotein A-IV inhibits experimental colitis

The antiatherogenic properties of apoA-IV suggest that this protein may act as an anti-inflammatory agent. We examined this possibility in a mouse model of acute colitis. Mice consumed 3% dextran sulfate sodium (DSS) in their drinking water for 7 days, with or without daily intraperitoneal injections of recombinant human apoA-IV. apoA-IV significantly and specifically delayed the onset, and reduced the severity and extent of, DSS-induced inflammation, as assessed by clinical disease activity score, macroscopic appearance and histology of the colon, and tissue myeloperoxidase activity. Intravital fluorescence microscopy of colonic microvasculature revealed that apoA-IV significantly inhibited DSS-induced leukocyte and platelet adhesive interactions. Furthermore, apoA-IV dramatically reduced the upregulation of P-selectin on colonic endothelium during DSS-colitis. apoA-IV knockout mice exhibited a significantly greater inflammatory response to DSS than did their WT littermates; this greater susceptibility to DSS-induced inflammation was reversed upon exogenous administration of apoA-IV to knockout mice. These results provide the first direct support for the hypothesis that apoA-IV is an endogenous anti-inflammatory protein. This anti-inflammatory effect likely involves the inhibition of P-selectin-mediated leukocyte and platelet adhesive interactions.

Induction of complete tumor necrosis may reduce intrahepatic metastasis and prolong survival in patients with hepatocellular carcinoma undergoing locoregional therapy: a prospective study

BACKGROUND

Transarterial chemoembolization (TACE) and percutaneous acetic acid injection (PAI) are effective locoregional therapies for hepatocellular carcinoma (HCC). This study aimed to investigate whether HCC patients who had initial complete response to these treatments had a subsequent lower risk of intrahepatic metastasis.

PATIENTS AND METHODS

A total of 152 patients who underwent locoregional therapy (94 received PAI and 58 received both TACE and PAI) for HCC (tumor size < or =5 cm) were prospectively evaluated.

RESULTS

In all, 60 (39%) patients had a complete tumor necrosis after treatment. The cumulative incidence of the development of intrahepatic metastasis was lower for patients with complete remission (P = 0.005) and for patients with smaller (< or =3 cm) tumor size (P = 0.083). Cox multivariate survival analysis showed that absence of complete remission [relative risk (RR) 2.7; 95% confidence interval (CI) 1.4-5.3; P = 0.003] was the only independent factor that predicted the occurrence of intrahepatic metastasis. Patients with complete remission had a significantly better long-term survival than those without (P = 0.002), and the occurrence of intrahepatic metastasis over time independently predicted a decreased survival (RR 3.2; 95% CI 2.0-6.1; P = 0.019).

CONCLUSIONS

Induction of complete tumor necrosis in HCC patients undergoing locoregional therapy may decrease the risk of intrahepatic metastasis and improve survival.

Site-specific methylene blue delivery to pilosebaceous structures using highly porous nylon microspheres: an experimental evaluation

PURPOSE

This study aimed to evaluate the penetration of methylene blue (MB)-loaded microspheres into pilosebaceous structures of rats.

MATERIALS AND METHODS

MB was incorporated into 5 microm highly porous nylon microspheres. The microspheres were dispersed into fluid silicone. Male hairless rats were used to evaluate the penetration of MB into hair follicles. After formulation application, MB diffusion was induced and skin biopsies were realized immediately, 2 and 26 hours after MB loaded microspheres application. MB fluorescence was observed with a microscope expanded for fluorescence microscopy.

RESULTS

Position of microspheres and MB diffusion was dependent on delay between microspheres application and harvest. Inside the skin, MB was seen exclusively in the hair follicle and the sebaceous glands. MB diffusion varied from 160+/-50 microm (2 hours after application) to 410+/-70 microm (26 hours after application). MB was also found in the sebaceous glands.

DISCUSSION

This study confirms that 5 micro m microspheres are optimally deposited deep within the pilosebaceous structure. In agreement with the literature, when microspheres are topically applied on the skin, they penetrate via a "lipid-rich channel" coating the hair follicles. MB is exclusively distributed in the hair follicles and their accessories.

CONCLUSION

This report presents evidence of MB pilosebaceous delivery through the use of microsphere formulation. This is obtained thanks to topical enhancement via the follicular route. This drug delivery system aims to transport MB into the pilosebaceous unit specifically and deeply. Various other applications could derive from this work. For example, such a method might be used to increase the therapeutic index of drugs directed at hair sebaceous gland disorders. Laser treatment of acne or laser hair removal could also benefit of this technique.

Linking lysosomal biomarker and population responses in a field population of Aporrectodea caliginosa (Oligochaeta) exposed to the fungicide copper oxychloride

The effects of the fungicide copper oxychloride on a field population of the earthworm Aporrectodea caliginosa were investigated. Changes were monitored in earthworm numbers and biomass, copper concentrations in soil and earthworms, and neutral red retention times (NRRTs) of coelomocytes. The aim was to establish whether the cellular responses could be linked to changes at the population level. Results indicated that there was a significant (P<0.05) impact on worm density and biomass on the treated plots 6 months after spraying with the fungicide stopped. NRRTs of treated earthworms were significantly lower after one spraying when earthworms had elevated concentrations of copper in their body tissues. Six months after spraying stopped, copper levels in both soil and earthworm tissues declined significantly, but the earthworm numbers and biomass were still significantly lower in the treated plots. This indicated that the effects of the copper oxychloride exposure manifested at a much later stage at the population level, than on NRRT. We conclude that the decrease in NRRTs, which preceded the decrease in both earthworm biomass and numbers, may have predictive value as a biomarker of impending population changes.

Tissue Chemoablation

PURPOSE

To provide an overview of the state of the art of tissue chemoablation in animal and human organs and cancers. We also describe our experience with the feasibility, predictability, and reproducibility of necrosis produced by needle chemoablative therapies including ethanol, hypertonic saline, and acetic acid solutions as well as gels in a porcine renal model.

MATERIALS AND METHODS

A MEDLINE search was performed for articles on animal and human tissue chemoablation published since 1965. In addition, at Washington University, experimental chemoablation was performed in pigs with 95% ethanol (4 mL), 24% hypertonic saline (4 mL), or 50% acetic acid (4 mL) solutions as well as in gel form.

RESULTS

There is extensive literature on the use of chemoablation for liver metastases; recently, chemoablation of the prostate has become an area of research. Human studies have been limited to patients who are not surgical candidates or to investigational procedures performed prior to definitive prostatic surgery. Animal studies of renal chemoablation as a sole therapy have produced mixed results. In our studies, only acetic acid provided complete necrosis.

CONCLUSIONS

To date, ethanol chemoablation has been shown to be feasible and reproducible only for metastatic hepatic carcinoma. In urology, chemoablation is still very much in the investigational stage for both the prostate and the kidney. A significant drawback is that even in the gel form, the spread of the chemoablative substance through the tissue is irregular and unpredictable. In the future, chemoablation may become a more effective modality by combining it with radiofrequency or other energy sources.

Safety assessment of recombinant green fluorescent protein orally administered to weaned rats

Several proposed biotechnological applications of green fluorescent protein (GFP) are likely to result in its introduction into the food supply of domestic animals and humans. We fed pure GFP and diets containing transgenic canola expressing GFP to young male rats for 26 d to evaluate the potential toxicity and allergenicity of GFP. Animals (n = 8 per group) were fed either AIN-93G (control), control diet plus 1.0 mg of purified GFP daily, modified control diet with 200 g/kg canola (Brassica rapa cv Westar), or control diet with 200 g/kg transgenic canola containing one of two levels of GFP. Ingestion of GFP did not affect growth, food intake, relative weight of intestine or other organs, or activities of hepatic enzymes in serum. Comparison of the amino acid sequence of GFP to known food allergens revealed that the greatest number of consecutive amino acid matches between GFP and any food allergen was four, suggesting the absence of common allergen epitopes. Moreover, GFP was rapidly degraded during simulated gastric digestion. These data indicate that GFP is a low allergenicity risk and provide preliminary indications that GFP is not likely to represent a health risk.