Curative Criteria After Endoscopic Resection for Superficial Esophageal Squamous Cell Carcinomas.

BACKGROUND: According to the Japanese Esophageal Society (JES) guidelines, risk factors for lymph node (LN) metastasis in the muscularis mucosa (MM)/submucosa to a depth of up to 200 µm (SM1) in cases of esophageal squamous cell carcinomas (ESCCs) include the presence of lymphatic invasion (ly), venous invasion (v), infiltration pattern (INF)c, and SM1. The long-term prognoses of these patients are unclear, and there are very few reports on the validation of the curative criteria for MM/SM1 ESCCs. AIMS: To examine the long-term prognoses of these patients and the risk factors for LN metastasis of MM/SM1 ESCCs after endoscopic resection (ER). METHODS: This study included patients with MM/SM1 ESCCs who underwent ER at Hiroshima University Hospital from December 1990 to November 2016. We evaluated the clinicopathological characteristics of 98 patients and overall survival, disease-specific survival, recurrence-free survival, and recurrence rates in the e-curative and non-e-curative groups. RESULTS: The mean observation period was 75 months. There was no significant difference in disease-specific survival rate between the e-curative and non-e-curative groups (100 vs. 98%). There was no significant difference in disease-specific survival rates between the groups (100 vs. 98%). In contrast, the LN recurrence-free survival rate in patients with INFa, ly(-), and v(-) was significantly higher than that in patients with INFb/c, ly(+), or v(+) (100 and 87%, P < 0.05). CONCLUSION: Contrary to the JES guidelines, our findings suggest that new criteria (MM/SM1, INFa, negative vertical margin (VM0), ly[-], and v[-]) may be associated with curative ER without additional treatment.

Diagnosis of superficial esophageal squamous cell carcinoma invasion depth before endoscopic submucosal dissection.

Endoscopic submucosal dissection (ESD) is a widely accepted procedure for superficial esophageal squamous cell carcinoma (SESCC) limited to the epithelium or lamina propria mucosae (EP/LPM). We aimed to compare the efficacy of endoscopic ultrasonography (EUS) and magnifying endoscopy with narrow band imaging (ME-NBI) for predicting the tumor invasion depth in patients with SESCC. Specifically, we evaluated the ability of these examinations to distinguish EP/LPM from SESCC invading the muscularis mucosae or superficial submucosa (MM/SM1) and more deeply invasive lesions before ESD.We retrospectively analyzed a database of all patients with SESCC who had undergone both EUS and ME-NBI for pretreatment staging and ESD resection at Hiroshima University Hospital between September 2007 and June 2015. The clinicopathologic characteristics of SESCCs were classified according to the Japanese Classification of Esophageal Cancer.A total of 174 lesions in 174 patients were included: 124 (71%) EP/LPMs, 35 (20%) MM/SM1s, and 15 (9%) SESCCs invading the mid submucosae (SM2). The sensitivity of EUS and of ME-NBI in distinguishing EP/LPM from MM/SM1 and more invasive lesions was 72% and 83%, respectively. The accuracy of EUS and ME-NBI in distinguishing EP/LPM from MM/SM1 and more invasive lesions was 70% and 82%, respectively. Sensitivity and accuracy of ME-NBI in distinguishing EP/LPM from MM/SM1 and more deeply invasive SESCCs is significantly higher than those of EUS (P = 0.048 and P = 0.017, respectively).ME-NBI may be more useful than EUS for the determination of SESCC invasion depth before ESD.

Ce:YIG/Silicon-on-Insulator waveguide optical isolator realized by adhesive bonding.

A waveguide optical isolator realized by adhesive bonding of a garnet die, containing a Ce:YIG magneto-optic layer, on a silicon-on-insulator waveguide circuit is demonstrated. The die was bonded on top of an asymmetric Mach-Zehnder interferometer using a 100nm thick DVS-BCB adhesive bonding layer. A static magnetic field applied perpendicular to the light propagation direction results in a non-reciprocal phase shift for the fundamental quasi-TM mode in the hybrid waveguide geometry. A maximum optical isolation of 25 dB is obtained.

[Coronary artery bypass grafting in patients with dialysis-dependent renal failure].

From January 1995 to May 2003, 36 patients with dialysis-dependent renal failure underwent coronary artery bypass grafting. We performed the operation with cardiopulmonary bypass (group On) in 17 cases and without cardiopulmonary bypass (group Off) in 19 patients [off-pump coronary artery bypass grafting (OPCAB) 15, minimally invasive direct coronary artery bypass (MIDCAB) 4]. There were no statistical differences regarding mean age, sex, duration of dialysis, preoperative hypertension, diabetes and peripheral and cerebral vascular diseases. Mean operation time and the number of bypass grafts were 315 +/- 53 minutes, 2.8 +/- 0.8 grafts in group On and 284 +/- 78 minutes, 2.4 +/- 1.1 grafts in group Off, respectively (not significant). Seventeen patients (100%) of group On and 12 patients (63%) needed blood transfusion. Hospital stay after operation was significantly longer in group On (40 days) of group Off than that in group Off (26 days). After the operation, continuous hemodiafiltration (CHDF) was used in 10 cases (59%) in group On and 3 cases (16%) in group Off. In coronary artery bypass grafting (CABG) on dialysis patient, it is very effective to have various operation techniques, such as off-pump bypass and on-pump beating bypass. Also control of water-electrolyte balance using early postoperative CHDF is useful. However, off-pump cases could be controlled by conventional hemodialysis.

[Ascending aorta to biaxillar and left femoral artery bypass].

A 68-year-old man was admitted to our hospital because of ischemia in the upper and lower extremities with rest pain. Aortography revealed complete bilateral subclavian artery occlusion and left femoral artery occlusion. We planned simultaneous revascularization of upper and lower extremities. Ascending aorta to biaxillar and left femoral artery bypass was performed. The postoperative course was uneventful and he was discharged on the 18th day after operation. This procedure was useful for patient with upper and lower limb ischemia.

[Dor operation for left ventricular aneurysm with sustained ventricular tachycardia].

A 60-year-old woman was admitted to our hospital because of syncope attack due to sustained ventricular tachycardia (VT). She was treated medically after cardiopulmonary resuscitation. Coronary arteriography revealed a 99% stenosis of right coronary artery (posterior descending artery: # 4 PD), a 90% stenosis of left descending artery (# 6) and left akinetic aneurysm was demonstrated. The patient successfully underwent Dor operation with endocardial cryoablation. The postoperative course was uneventful and the recurrence of VT was never recognized clinically.

Glucocorticoid-induced modulation of the beta-adrenergic adenylate cyclase response of epidermis: its relation to epidermal phospholipase A2 activity.

It has been suggested that glucocorticoids produce their biologic effects through the synthesis of phospholipase A2 inhibitor protein (lipocortin) in various cell systems. Recent studies from our laboratory revealed that glucocorticoids augment the beta-adrenergic adenylate cyclase response of epidermis and that this effect depends on a protein synthesis mechanism. In order to elucidate the possible mechanism of this glucocorticoid effect in terms of phospholipase A2 activity, an in vitro pig skin incubation system was employed. Mepacrine, a phospholipase A2 inhibitor, augmented the beta-adrenergic adenylate cyclase response of epidermis as glucocorticoids. The effect of mepacrine was stronger and was observed earlier than that of glucocorticoid (hydrocortisone). The addition of both mepacrine and hydrocortisone at their optimal concentrations in the incubation medium, resulted in neither an additive nor a synergistic effect on the beta-adrenergic augmentation. On the other hand, melittin, a phospholipase A2 stimulator, depressed the beta-adrenergic adenylate cyclase response. The addition of both melittin and hydrocortisone in the incubation medium resulted in the inhibition of the hydrocortisone-induced beta-adrenergic augmentation effect. Following long-term incubation with hydrocortisone, the epidermal phospholipase A2 activity was significantly decreased. These results indicate that glucocorticoids might affect the beta-adrenergic adenylate cyclase response of epidermis through the synthesis of phospholipase A2 inhibitor protein (lipocortin) as in other cell systems.

Calmodulin activities are significantly increased in both uninvolved and involved epidermis in psoriasis.

In order to elucidate a part of calmodulin actions in the hyperproliferative state in human epidermis, calmodulin activities in the psoriatic and in the normal human epidermis were determined using calmodulin-deficient phosphodiesterase from bovine heart and purified pig skin epidermal calmodulin as a standard. Skin samples were obtained from 11 normal healthy controls and from both the uninvolved and involved regions of 8 nonconsanguineous psoriatic patients. Pure epidermal samples, prepared by the microdissection method, were used for calmodulin assays. Normal human epidermis contained 270 +/- 13 ng/mg dry weight, whereas calmodulin activities were significantly increased in psoriatic epidermis, 412 +/- 29 ng/mg dry weight for the uninvolved epidermis and 747 +/- 46 ng/mg dry weight for the involved epidermis, respectively. These results suggest that calmodulin may play an important role in cell proliferation in human epidermis.

Erythropoietin in pediatric cardiac surgery: clinical efficacy and effective dose.

We assessed the clinical efficacy and determined the effective dose of erythropoietin (EPO) in 48 children scheduled for open heart surgery without blood transfusion. The children were divided into three groups: group 1 (n=21) was treated with 300 U/kg of EPO; group 2 (n=11) was treated with 150 U/kg of EPO; and group 3 (n=16) was not treated with EPO. EPO was administered on the day of hospital admission (6 to 7 days prior to surgery), on the following day, immediately after surgery, and on the following day. Immediately after surgery, the hemoglobin concentration in groups 1 and 2 was significantly higher than that in group 3. The reticulocyte count in groups 1 and 2 was significantly higher than that in group 3. Open heart surgery was completed without transfusion in all 21 patients in group 1 (100%), 10 of 11 in group 2 (90.9%), and 11 of 16 in group 3 (68.8%). EPO caused no adverse reactions. In conclusion, EPO was effective as an adjuvant therapy for open heart surgery without blood transfusion in children. Administration of a relatively high dose of EPO (300 U/kg) seems to be effective for pediatric patients.

New surgical method of chordal replacement for mitral valve incompetence with echocardiographic guidance. An experimental study.

Chordal replacement with expanded polytetrafluorethylene suture has become a procedure of choice for repairing anterior leaflet prolapse among certain surgeons. However, most surgeons believe that the chordal replacement is too complicated and not reproducible. This report introduces a new method of chordal replacement using intraoperative epicardial and transesophageal echocardiography. Three dogs underwent the following procedures. One major marginal chorda of an anterior mitral leaflet was resected during cardiopulmonary bypass. A specially designed 3-0 polytetrafluoroethylene suture, having straight needles, was attached to the anterior leaflet by a mattress suture. Then the needles were brought from the root of the anterior papillary muscle to the outside of the left ventricle. After the bypass flow was reduced, both ends of the polytetrafluoroethylene suture were pulled under echocardiographic guidance until valve competence was achieved. At that point, the suture was temporarily tied. When cardiopulmonary bypass was discontinued, competence was again confirmed and the suture was tied permanently. When the procedures were completed, echocardiography showed trivial regurgitation and good pliability of the anterior leaflets in all animals. Left atrial pressures were sufficiently decreased. It appears that this new technique is reproducible for all surgeons because the optimal length of polytetrafluoroethylene chordae is determined with the valve functioning.

Thymidylate synthase levels as a therapeutic and prognostic predictor in breast cancer.

5-Fluorouracil (5-FU) is a commonly used adjuvant therapeutic drug in treating breast cancer. 5-FU is metabolically converted to 5-fluorouracil-2'-deoxyuridine-5'-monophosphate-(FdUMP) which is believed to inhibit DNA synthesis in neoplastic cells by forming a tightly bound ternary complex with thymidylate synthase (TS). In the present study, we examined the possible relationship between TS levels and clinico-pathologic and prognostic features in breast disease. Mean TS levels of 2.9 pmol/g, 6.1 pmol/g, and 23.1 pmol/g were obtained in cases of benign breast disease (3 cases), primary breast cancer (115 cases), and recurrent tumors (4 cases), respectively. In breast cancer, mean TS levels significantly correlated with S-phase fraction (SPF), DNA polymerase a and lymphatic invasion. Thus, TS levels in breast cancer significantly reflected cell proliferation and malignancy. Regarding the survival rate, patients with TS values above 10 pmol/g showed an unfavorable prognosis. The effectiveness of adjuvant 5-FU derivatives chemotherapy was reflected in a higher disease-free survival rate in node (+) cases showing TS levels between 5 and 10 pmol/g (p < 0.1), but not in node (-) cases. In conclusion, TS levels in neoplastic tissues of the breast were highest in recurrent tumors, followed by those in primary cancer, benign breast disease and in breast cancer which reflected proliferative activity. Breast cancers with extremely high TS levels were accompanied by an unfavorable prognosis; however, those with moderately high TS levels tended to respond to adjuvant chemotherapy with 5-FU derivatives.

Pig-skin epidermal calmodulin: effects of antagonists of calmodulin on DNA synthesis of pig-skin epidermis.

Although epidermal keratinocytes contain significant amounts of calmodulin, the exact role of calmodulin in epidermal biological activity remains to be determined. Pig-skin (epidermal) calmodulin was purified to homogeneity by DEAE/Sepharose- and phenothiazine-affinity-column chromatography. The characteristics of the purified calmodulin proved to be in good agreement with those of calmodulin obtained from other sources. Phenothiazines (trifluoperazine and chlorpromazine), mepacrine, propranolol, and colchicine inhibited the effect of the purified epidermal calmodulin on the calmodulin-deficient phosphodiesterase of bovine heart. These calmodulin antagonists all had inhibitory effects on the thymidine incorporation of pig-skin epidermal keratinocytes. These observations support the assumption that calmodulin might play an important role in epidermal keratinocyte proliferation.

[Mutagenicity tests of suplatast tosilate (IPD-1151T)].

1. The reverse mutation test was carried out on suplatast tosilate (IPD-1151T) at dose range of 50-5000 micrograms/plate using Salmonella typhimurium strains TA100, TA1535, TA98 TA1538 and TA1537, and Escherichia coli strains WP2, WP2uvrA. In all tester strains no significant differences were observed in the number of revertant colonies as compared with solvent control in the absence or presence of mammalian metabolic activation system. 2. The chromosomal aberration test on IPD-1151T was carried out using cultured Chinese hamster lung cells (CHL). The cells were treated with IPD-1151T at the doses of 125, 250 and 500 micrograms/ml without S9 Mix and at the doses of 1250, 2500 and 5000 micrograms/ml with S9 Mix. The incidence of structural- and numeral-aberration was 0-4% in the absence or presence of mammalian metabolic activation system, no significant increases were observed in the incidence of chromosomal aberrations. 3. The micronucleus test using BDF1 male mice was conducted in order to evaluate the in vivo mutagenicity of IPD-1151T. IPD-1151T was orally administered at doses of 625, 1250, 2500 and 5000 mg/kg, with a sampling time of 24 hr. The frequency of polychromatic erythrocytes with micronuclei (MNPCE) was 0.23% in the lowest dose (625mg/kg) of IPD-1151T, but the frequency of MNPCE was 0.03-0.13% in the groups treated with 1250-5000 mg/kg of IPD-1151T and no significant increases were observed with dose dependence. The results indicated that IPD-1151T was negative, even in the assessment standard using our background data. 4. The present study indicates that IPD-1151T has no in vitro and in vivo mutagenic potential.

[Antigenicity tests of suplatast tosilate (IPD-1151T)].

Antigenicity of suplatast tosilate (IPD-1151T) was investigated in guinea pigs and mice. The results were as follows: 1. Homologous passive cutaneous anaphylaxis (PCA), active systemic anaphylaxis (ASA), active cutaneous anaphylaxis (ACA) and Schultz-Dale reaction tests were carried out using guinea pigs which were immunized orally with IPD-1151T alone or subcutaneously with IPD-1151T and Freund's complete adjuvants (CFA). Positive reactions in these tests were not produced by eliciting injection of IPD-1151T or its metabolite, M-1. On the other hand, the sensitization of ovalbumin (OVA) with CFA produced positive reactions in all of PCA, ASA, ACA and Schultz-Dale tests. 2. Heterologous passive cutaneous anaphylaxis (PCA) test using rats was carried out using two strains of mice (C3H/He and BALB/c) which were immunized orally with IPD-1151T alone or intraperitoneally with IPD-1151T and aluminum hydroxide gel (Alum) as an adjuvant. No animals showed positive reaction to both eliciting antigens, IPD-1151T and M-1. On the other hand, a positive reaction in PCA test to eliciting antigen, OVA, was obtained in rats treated with sera of mice sensitized with OVA plus Alum. 3. These findings showed that IPD-1151T had no antigenicity in guinea pigs and mice.

Reversible inhibition of keratinocyte thymidine incorporation by the calmodulin antagonist, W-7.

Although calmodulin has been suggested as an important regulator of keratinocyte proliferation, its precise role remains unknown. We employed a calmodulin antagonist, N-(6-aminohexyl)-5-chloro-1-naphthalenesulfonamide (W-7), to examine the role of calmodulin on keratinocyte proliferation. N-(6 aminohexyl-1-naphthalenesulfonamide (W-5), a chlorine-deficient analogue of W-7 with little anti-calmodulin activity, was used as the control. W-7 markedly inhibited thymidine incorporation of pig epidermis at concentrations close to its anti-calmodulin activity; W-5 had no effect on the thymidine incorporation. The inhibitory effect of W-7 was reversible; the removal of W-7 from the incubation medium resulted in the reinitiation of the thymidine incorporation, suggesting that W-7 is not a cytotoxic agent. These results are consistent with the view that calmodulin is an essential regulator of keratinocyte proliferation. The epidermal beta-adrenergic response, which is decreased in various hyperproliferative epidermal abnormalities, was increased in W-7-treated hypoproliferative epidermis. The epidermal SOD activity, which is also decreased in the hyperproliferative epidermis, however, was not affected by the W-7 treatment.

Evaluation of third generation anti-HCV test kit (SYNPEP HCV-EIA II) using sera of inhabitants from HCV hyperendemic area.

We examined the characteristics and usefulness of a third generation anti-HCV test kit, SYNPEP HCV-EIA II (Kyokuto Pharmaceutical Inc., Tokyo, Japan). The sera of inhabitants from a hepatitis C virus (HCV) hyperendemic area were used. The kit had even or more anti-HCV detection sensitivity and reproducibility than ORTHO HCV III ELISA Test System (Ortho-Clinical Diagnostic K.K., Tokyo, Japan) or HCV PHA 2nd Generation (Dinabot Co., Ltd., Tokyo, Japan). SYNPEP HCV-EIA II needed less total reaction time than other EIA kits, resulting in a simple procedure. Also, HCV RNA was detected in 90% of subjects who had a 7.5 or greater cut-off index (COI) of SYNPEP HCV-EIA II kit. In conclusion, SYNPEP HCV-EIA II require cheap cost and simple procedure and it could be applied to mass screening to find out HCV RNA positive persons who may need clinical care.

[Clinical laboratory data and reference intervals standardized in Fukuoka].

In Fukuoka whose population is approximately five million inhabitants, surveys on the accuracy of laboratory data have been performed by the Fukuoka Prefecture Medical Association for the last 30 years. We have been attempting to evaluate the data for routine use since 1988, and it has become possible to share laboratory data between all institutions in Fukuoka prefectures. As a result, reference intervals for 23 clinical chemistry analytes were established in 1995, to which were added in 1996 five serum protein constituents that have been utilized for clinical examinations. Methods for documentations and monitorings the data obtained in the prefecture were also established, standardization of the above analytes extended to 97% of the institutions in the prefecture. Results for 14 of the 23 clinical chemistry analytes have become highly reliable and clinically useful as differences between institutions in terms of results have narrowed. Standardization of other analytes is now in progress.

[The 5q- syndrome associated with marked erythroid hypoplasia and Coombs test positive hemolysis].

The 5q- syndrome is a myelodysplastic disorder characterized by macrocytic anemia, hypolobulated micromegakaryocytic hyperplasia, and an interstitial deletion of chromosome 5 as a solitary cytogenetic abnormality. The majority of patients with this syndrome are elderly women exhibiting red blood cell transfusion-dependent refractory anemia with a normal-to-increased number of platelets and modest granulocytopenia. The prognosis is relatively favorable with a low incidence of leukemic transformation. We report on a patient with 5q- syndrome associated with autoimmune hemolytic anemia (AHIA) and severe erythroid hypoplasia mimicking pure red cell aplasia (PRCA). A 65-year-old woman was admitted because of severe anemia. Elevated serum levels of LDH and indirect bilirubin, and a positive direct Coombs' test suggested AIHA associated with a huge ovarian dermoid cyst. However, lack of peripheral reticulocytes and bone marrow eryhroblasts, characteristic megakaryocytic morphology, and solitary 5q- anomaly favored a diagnosis of 5q- syndrome complicated by PRCA-like feature. Underlying immunological abnormalities ascribed to aberrant lymphoid clones intrinsic to MDS may be responsible for red cell aplasia and autoantibodies against red blood cells.