Vitrification and nanocrystallization of pure liquid Ni studied using molecular-dynamics simulation.

Structural variation, vitrification, and crystallization processes in liquid nickel are simulated on continuous cooling and isothermal holding using a classical molecular-dynamics computer simulation procedure with an embedded-atom method potential at constant pressure. Structural changes are monitored with direct structure observation in the simulation cells, as well as by pair distribution and radial distribution functions created using the atomic coordinates. A cluster analysis is also performed. The crystallization kinetics is analyzed under isothermal conditions by monitoring density and energy variation as a function of time. As a result, a time-temperature-transformation diagram can be constructed over a wide temperature range.

Clinical application of evoked spinal cord potentials elicited by direct stimulation of the cord during temporary occlusion of the thoracic aorta.

Evoked spinal cord potentials elicited by direct stimulation of the cord were used to monitor spinal cord ischemia in 68 patients undergoing temporary occlusion of the thoracic aorta (29 thoracic nondissecting aortic aneurysms, 9 nondissecting thoracoabdominal aneurysms, and 30 dissecting aneurysms). "Immediate" postoperative paraplegia developed in three patients and "immediate" paraparesis developed in one, whereas "delayed" paraplegia developed in two others. During aortic crossclamping, four response patterns of the spinal cord potentials were obtained: (1) no change (n = 53), (2) change with return (n = 10), (3) change with inconsistent return (n = 2), and (4) change without return (n = 3). Neurologic complications occurred in 2%, 0%, 100% of these groups, respectively. Delayed paraplegia developed on the second postoperative day in only one patient with a false-negative result, and the potentials correlated well with this patient's clinical neurologic recovery. The aortic crossclamp time was significantly longer in the patients with "change with inconsistent return" and "change without return" than in the other two groups (p < 0.01). Femoral artery pressure and the cardiopulmonary bypass flow rate were also significantly lower in these groups than in the other two groups (p < 0.02 and p < 0.01, respectively). We conclude that intraoperative monitoring of direct spinal cord responses is useful for the early detection of spinal cord ischemia for assessing the efficacy of surgical countermeasures.

Direct mechanical assistance of the right ventricle with the Hemopump in a porcine model.

In 6 pigs, a 14F Hemopump was placed through the pulmonary artery into the right ventricle. The pulmonary artery was banded proximal to the outflow port of the Hemopump, and tightening the band increased right ventricular peak systolic pressure by 50%. There were significant falls in right ventricular stroke volume (from 43 +/- 7.3 mL [+/- the standard deviation] to 27 +/- 8.0 mL; p < 0.001) and cardiac output (from 4.94 +/- 0.76 L/min to 3.70 +/- 0.95 L/min; p < 0.01) and increases in right ventricular peak systolic pressure (from 28 +/- 9.7 mm Hg to 42 +/- 17.1 mm Hg; p < 0.01) and end-diastolic pressure (from 2 +/- 0.8 mm Hg to 12 +/- 6.4 mm Hg; p < 0.02). Mean aortic pressure fell (from 65 +/- 29.9 mm Hg to 61 +/- 9.6 mm Hg; p < 0.01), but systemic vascular resistance was unchanged, thus indicating a fall in left ventricular output reflected by a decrease in mixed venous oxygen saturation (from 60% +/- 8.9% to 47% +/- 7.6%; p < 0.01). After 15 minutes with the Hemopump at maximum speed, these variables returned to control levels (stroke volume, 38 +/- 4.5 mL; cardiac output, 4.50 +/- 0.63 L/min; right ventricular peak systolic pressure, 29 +/- 8.3 mm Hg; right ventricular end-diastolic pressure, 4 +/- 2.0 mm Hg; mean aortic pressure, 72 +/- 10.4 mm Hg; mixed venous oxygen saturation, 56% +/- 4.6% [all, p = not significant versus controls]).(ABSTRACT TRUNCATED AT 250 WORDS)

The gastrointestinal tract: an underestimated organ as demonstrated in an experimental LVAD pig model.

BACKGROUND: Although hemodynamic stability and renal function are important and are monitored closely in patients with implanted left ventricular assist devices (LVAD), the gastrointestinal tract may be underestimated in the early postoperative period with regard to adequate perfusion. We investigated renal, intestinal, and whole body metabolic changes in response to variations in LVAD flow and inspired oxygen concentration (FiO2). METHODS: Left ventricular assist devices were implanted in 10 adult pigs (weight, 55 +/- 1.76 kg). Renal vein (RV), superior mesenteric vein (SMV), and pulmonary artery (PA) blood oxygen saturation and lactate concentration were measured and used as tissue perfusion markers. These measurements were made at baseline and after changes in LVAD flow or FiO2. RESULTS: Oxygen saturation in the PA, SMV, and RV decreased significantly after a reduction in LVAD flow (P < 0.05), with a greater reduction in the SMV than in the PA and RV (p < 0.05 at LVAD flow 3.5L/min; p < 0.01 at LVAD flow 2.0 and 1.0 L/min). The lactate concentration in the PA and SMV increased significantly (p < 0.01) with decreased flow, with a greater increase in the SMV than in the PA (p< 0.05), whereas it remained unchanged in the RV. Oxygen saturation in the PA, SMV, and RV decreased significantly after a reduction in FiO2 (p < 0.05). Lactate concentration in the PA, SMV, and RV increased significantly at FiO2 of 0.10 (p < 0.05). Lactate concentration in the PA and SMV was significantly higher than that in the RV at Fi)2 of 0.10 (p < 0.01). CONCLUSIONS: The results show that the gastrointestinal tract is at high risk during low perfusion or low FiO2, whereas the kidneys' metabolic function appears to be less disturbed. In clinical practice, this emphasizes the need to ensure adequate blood flow and respiratory function, especially after extubation, in patients with implanted LVAD. This might avoid intestinal ischemia and subsequent endotoxemia. Gastrointestinal tonometry may help in the assessment of intestinal perfusion.

Postoperative adjuvant chemotherapy with cisplatin, etoposide, and pirarubicin for endometrial carcinoma patients with lymph node metastasis: A pilot study.

We evaluated the effects of a combined chemotherapy regimen on endometrial carcinoma in 14 patients with lymph node metastasis. After surgery, the patients were treated with 3 cycles of chemotherapy (PVP regimen) every 4 weeks. The PVP regimen consisted of 75 mg/m2 cisplatin on day 1, 40 mg/m2 pirarubicin (P) on day 1, and 75 mg/m2 etoposide (VP-16: V) on days 2, 3 and 4. The effect of adjuvant chemotherapy was evaluated based on progression-free survival (PFS), overall survival (OS), and adverse effects. The 5-year PFS rate was 52% [95% confidence interval (CI), 10-94%], and the 5-year OS rate was 50% (95% CI, 16-84%). The major toxicity was myelosuppression. One hundred percent of patients had neutropenia above grade 3, but all recovered from myelosuppression. PVP therapy may be an effective adjuvant therapy for endometrial carcinoma patients with lymph node metastasis used as an alternative to radiation therapy.

The role of 18F-fluoro-2-deoxy-D-glucose positron emission tomography (18F-FDG-PET) in the diagnosis of recurrence and lymph node metastasis of cervical cancer.

The usefulness of positron emission tomography with 2-[18F]-fluoro-2-deoxy-D-glucose (FDG-PET) in diagnosing recurrence and lymph node metastasis of uterine cervical cancer was evaluated as a preliminary study. The FDG uptake of 13 cervical cancer patients, including 4 patients with recurrence, was evaluated. The FDG uptake of the cervices of 5 patients who underwent PET studies for non-cervical tumors were used as control. In 2 patients who had undergone radical hysterectomy, we compared the diagnosis of lymph node metastasis based on FDG-PET and magnetic resonance imaging. The FDG uptake in the 9 primary cervical cancers was greater than that in normal cervices (p=0.025). Examination of the 4 recurrent tumors revealed a higher FDG uptake than that in normal cervices (p=0.0022). Metastatic lesions in lymph nodes showed an accumulation of FDG on the PET scan. In conclusion, FDG-PET may be an effective diagnostic tool for detecting recurrence and lymph node metastasis of uterine cervical cancers.

Remarkable suppressive effect of consecutive low-dose cisplatin therapy on advanced ovarian clear cell adenocarcinoma.

Ovarian clear cell adenocarcinoma (OCCA) is known to be less responsive to cisplatin and most other anti-cancer drugs and to have a poorer prognosis than other ovarian cancers. We report a rare case of stage IIIc OCCA in a patient who has been treated postoperatively with cisplatin alone and continues to survive after 7.5 years. In this case, 25 mg/m2/day of cisplatin was administered for 5 consecutive days every 4 weeks. After remission, intermittent administration of cisplatin every 3 to 4 months was performed 8 times. This case suggests that induction and intermittent chemotherapy using consecutive low-dose cisplatin administration may be a useful treatment for OCCA.

Early diagnosis and evaluation of therapy in postoperative recurrent cervical cancers by positron emission tomography.

Positron emission tomography (PET) using 2-[18F]fluoro-2 deoxy-D-glucose (FDG) was performed on two uterine cervical cancer patients in whom recurrent tumors, one pelvic and the other at the vaginal wall had not been precisely diagnosed using the usual imaging examinations. One recurrence was confirmed by the acccumulation of FDG to the pelvic mass as detected by magnetic resonance imaging (MRI). During chemotherapy, changes in FDG-PET findings were detected earlier than those in MRI. In the other, PET detected a recurrent tumor that could not be found by MRI, and was also useful for evaluating chemotherapeutic effects. These cases suggest that PET with FDG can be a useful examination not only for diagnosing recurrent cervical cancer after radical hysterectomy, especially pelvic recurrence, but also for evaluating chemotherapeutic effects on recurrent cancers.

Combined diagnostic imaging of uterine carcinosarcoma: A case report.

The diagnostic imaging characteristics of uterine carcinosarcoma have not been established because the tumor is very rare. We studied magnetic resonance (MR) imaging, power Doppler ultrasonography, and positron emission tomography (PET) in one such carcinosarcoma to define its imaging characteristics. On T1-weighted MR images, the tumor mass in the uterus was low-signal intensity and had a slight inhomogeneous appearance. On T2-weighted images, it had a heterogeneous appearance and was of medium- or high-signal intensity; marked flow void was apparent from the myometrium to the tumor mass. The MR flow void was also detected by power Doppler ultrasonography. Increased glucose metabolism was detected on PET images, suggesting a malignant tumor in the endometrial cavity. Combined diagnostic images with MR, power Doppler ultrasonography, and PET is recommended as the diagnostic method for uterine carcinosarcoma.

Successful preoperative diagnosis of massive ovarian edema aided by comparative imaging study using magnetic resonance and ultrasound.

Massive ovarian edema (MOE) is a rare disease. Therefore, preoperative diagnostic method of massive ovarian edema (MOE) has not been established. We have succeeded in making a preoperative diagnosis of MOE aided by ultrasonogram and magnetic resonance imaging (MRI) and the patient's ovaries were preserved. Characteristics and proposed diagnostic imaging criteria for MOE are discussed.

Enhanced Fas/CD95-mediated apoptosis by epidermal growth factor in human endometrial epithelial cells.

Epidermal growth factor (EGF) has been reported to regulate apoptosis in various cell lineages. Throughout the menstrual cycle overexpression of the EGF receptor in the secretory epithelium and constitutive expression of EGF in all types of endometrial cells were identified by immunohistochemical study of normal human endometrial tissues. However, it is not known whether EGF also regulates endometrial apoptosis. This study examined the regulatory functions of EGF in endometrial apoptosis by using a human endometrial epithelial cell line HHUA which is susceptible to Fas-mediated apoptosis. Although EGF alone did not affect the cell growth of HHUA, EGF pretreatment of HHUA enhanced Fas-mediated growth suppression and Fas-mediated DNA fragmentation in the cells. Flowcytometric analyses demonstrated that EGF did not induce Fas expression on the cell surface while expressions of the EGF receptor were down-regulated. These results suggest that EGF may enhance apoptotic susceptibility of the endometrial epithelium, especially in the secretory epithelium.

Comparison of Salmonella isolation rates in different types of egg-layer hen houses in Chiba, Japan.

This study investigated the differences in Salmonella isolation rates in environmental samples taken from several types of hen houses in Chiba, Japan. In addition, for the detailed epidemiologic survey, environmental samples, hens, and rodents were collected from Salmonella-contaminated windowless houses on three farms. As a result, Salmonella was isolated from four (80%) of five farms with windowless hen houses; Salmonella enteritidis was isolated from a single windowless house. In contrast, only one serotype of Salmonella was isolated from 1 (6.7%) of 15 farms with open hen houses. In the S. enteritidis-contaminated windowless hen house, the isolation rates of S. enteritidis as compared with the other serotypes were 90.9% of environments, 94.1% of hens, and 86.4% of roof rats (Rattus rattus) that resided in the environments. In reference to the phage type (PT) of these isolates, PT1 was detected in environments and roof rats, and PT9 was detected in both these samples and in hens. Thus, the Salmonella isolation rate in hen houses seems to be associated with whether the premises are windowless or open. Moreover, roof rats appear to be the most important vectors in the spread of S. enteritidis in the windowless hen house because the S. enteritidis PTs coincide with each other.

Use of the Nippon-Zeon pneumatic ventricular assist device as a bridge to cardiac transplantation.

The Nippon-Zeon (NZ) ventricular assist device is a sac type, air driven, heterotopic, external pump. Its performance has been evaluated in Japan as a bridge to myocardial recovery. Few data are available on the device as a bridge to heart transplantation. Since 1991, 10 patients (9 men) were bridged to heart transplantation with NZ, all in biventricular support. The mean age was 39 +/- 13 years (range, 21-60 years), mean body weight was 75 +/- 13 kg (range, 51-95 kg). Five patients had a dilated cardiopathy, and five were ischemic (three acute myocardial infarctions). Despite maximal inotropic support, including enoximone in seven, epinephrine in three, and intraaortic balloon pumping in one, eight patients were anuric, three were in acute hepatic failure, and three were intubated. Preoperative hemodynamic and biologic values were: cardiac index, 1.57 +/- 0.4 l/min/m2; pulmonary capillary wedge pressure, 34 +/- 5 mmHg; creatinine, 200 +/- 80 mumol/l; blood urea nitrogen, 17.5 +/- 8 mmol/l; total bilirubin 36 +/- 6 mumol/l; aspartate aminotransferase, 1,000 +/- 2,000 IU/l. In all patients, a biventricular assist device was implanted without the use of cardiopulmonary bypass. Improvement occurred immediately in all but one. Mean left ventricular flow was 4.5 +/- 0.8 l/min. Anticoagulation was maintained with intravenous heparin. Recently for bleeding was required in one case (10%), and two patients had positive blood cultures that were successfully treated. There was no mechanical failure. Hemolysis was not significant (lactate dehydrogenase, 378 +/- 50 IU/l; plasma-free hemoglobin below 10 mg/dl). Each device was free of thrombi and deposits at time of explantation. One patient died while on assist. Nine patients (90%) were transplanted after 11 +/- 8 days (range, 1-32 days). Three died early after transplantation, one of graft failure, two of sepsis. Six patients (66%) could be discharged. The follow-up ranges from 7 to 28 months. NZ is a simple, reliable, pneumatic device driven by a light, silent console; it can be rapidly implanted without cardiopulmonary bypass in patients in desperate condition who are awaiting cardiac transplantation. The difficulty of patient rehabilitation while using this device should limit the duration of support to weeks to allow the patient to be in optimal condition for heart transplantation.

Right heart function during left ventricular assistance in an open-chest porcine model of acute right heart failure.

Changes in the right ventricular function measured with a thermodilution ejection fraction catheter have been recorded in open-chest normal pigs and pigs with acute right heart failure (RVF) undergoing left ventricular assistance with a pneumatic-sac-type device (LVAD). To produce acute right heart failure, 5 pigs underwent ligation of the right ventricular free wall coronary arteries. Compared with normal pigs, cardiac output in ligated pigs fell by 21% (7.5 +/- 0.5 vs 9.5 +/- 1.2 L/min; p < 0.05) and the right ventricular end diastolic pressure rose (11.4 +/- 2.6 vs 5.7 +/- 3.6 vs mmHg: p < 0.05). With the left ventricular assist device connected, the right atrial pressure was increased to 3, 5, 7, 10 and 12 mmHg by volume loading while maintaining the haematocrit at 35 +/- 6%. The right ventricular stroke work index (RVSWI) increased with volume loading in normal pigs. In RVF pigs, RVSWI increased significantly with the LVAD (59.2 +/- 5.8 vs 23.5 +/- 7.8 mmHg ml/min/kg, p < 0.01), approaching that of normal pigs (62.3 +/- 4.8 mmHg ml/min/kg). Similar changes were observed in the cardiac output and right ventricular stroke volume. These results show that, in this model of open-chest, mild, acute right heart failure, left ventricular assistance allows right ventricular function to return to normal, despite volume overloading, by decreasing right ventricular after load and increasing right ventricular compliance.

Positron emission tomography using 2-[(18)F] fluoro-2-deoxy-D-glucose in the diagnosis of uterine leiomyosarcoma: a case report.

The preoperative diagnosis of uterine leiomyosarcoma (LMS) is very difficult. Magnetic resonance (MR) imaging is usually used for it; however, precise diagnosis by MR imaging is limited to typical LMS with coagulative tumor cell necrosis. We presented a case of LMS that was diagnosed preoperatively by positron emission tomography (PET) using 2-[(18)F] fluoro-2-deoxy-D-glucose (FDG).

Effect of adjuvant chemotherapy using pirarubicin, cisplatin, and etoposide (PEP) for stage IVB endometrial carcinoma: a case report.

Prognosis of patients with stage IVB endometrial adenocarcinoma is quite poor. Combination therapy of radiation with surgery or chemotherapy is a common therapy for advanced endometrial cancers. However, radiation therapy is effective only for localized cancer, and the chemotherapeutic effect on stage IVB endometrial cancers is very low. We present a patient with stage IVB endometrial adenocarcinoma, whose tumor was not resected completely at the first surgery. She showed a remarkable response to a PEP (pirarubicin, etoposide, cisplatin) regimen and has survived without disease over 8 years. This case suggests that reduction surgery following PEP therapy is a new therapeutic modality for stage IVB endometrial carcinoma.

Usefulness of positron emission tomography for diagnosis of malignancy in a calcified lesion: a case report.

When calcified lesions in the liver or spleen are found during follow-up of patients who have undergone debulking surgery and chemotherapy for advanced ovarian carcinoma, it is very difficult to differentiate recurrent cancer from secondary change after chemotherapy. We present here a patient in whom calcified lesions in the liver and spleen were diagnosed as malignancy on the basis of a preoperative PET study. Malignancy was confirmed by histologic examination after surgery.

In vitro decidualization activity assay of human endometrial stromal cells.

To address the need for a simple and reliable system for evaluating the effects of bioactive substances on decidualization of endometrial stromal cells, we designed and tested an assay for measuring decidualization activity. With our assay, it is easy to examine the effects of various bioactive substances on endometrial stromal decidualization. For example, as shown in this study, it is now clear that neither RANTES nor gonadotropin releasing hormone agonist has any effect on endometrial stromal decidualization. Our simple assay has also made it possible to evaluate individual stromal decidualization activities and the regulation of decidualization.

Identification of the granulocyte colony-stimulating factor (G-CSF) producing cell population in human decidua and its biological action on trophoblast cell.

Granulocyte colony-stimulating factor (G-CSF) is a hematopoietic factor, which induces differentiation and proliferation of immature granulocytes. During pregnancy, decidual tissue produces G-CSF and the receptor for G-CSF is expressed on chorionic villous tissues. This study attempted to determine the cell population responsible for G-CSF production in decidual tissue and the influence of G-CSF on trophoblasts. Immunostaining and in situ hybridization showed that both the decidual cells and macrophages in the decidual tissue were sources of G-CSF. With 50 micrograms of G-CSF, the [3H] thymidine uptake was 11,100 +/- 2,200 DPM and the control uptake was 7,970 +/- 1,820 DPM. G-CSF induced proliferation of trophoblasts 1.4-fold higher than that of control. It is concluded that the decidual cells and macrophages were sources of G-CSF in the decidual tissue, and G-CSF promoted trophoblast cell proliferation.

Pregnancy and neonatal outcomes in unexplained recurrent/habitual aborters treated by allogenic leukocyte immunization.

Allogenic leukocyte immunization is a common treatment of unexplained recurrent abortions, whose immunological side effects have hardly been reported. In this study, pregnancy and neonatal outcomes of unexplained recurrent/habitual aborters, who were treated by their husbands' leukocyte immunization, are reviewed. Seventy-seven patients were treated by their husbands' leukocyte immunization at the Infertility Cline of Osaka City University Hospital from 1985 to 1995. Among the 63 pregnancies after the immunizations, 47 cases succeeded in livebirths. Ten of the 47 cases were delivered by cesarean sections. There found no possible relationship between their operative indications and leukocyte immunizations in the 10 cases. As for pregnancy complications, two patients showed liver dysfunction. However we did not find any specific side effects in the pregnancy complications. There was no specific fetal/neonatal complications to the immunotherapy but a case of neonatal thrombocytopenia caused by maternal anti-HLA IgGs.