Management of isolated recurrence after surgery for pancreatic adenocarcinoma.

BACKGROUND: Recurrence of pancreatic cancer after primary pancreatectomy occurs in the vast majority of patients. The role of surgical treatment for recurrent pancreatic cancer is not well established. METHODS: Patients who underwent primary pancreatectomy with curative intent from 2000 to 2014 at a single large-volume centre were evaluated retrospectively. CT or PET was used to select patients with an isolated recurrence. The clinicopathological features and survival outcomes were compared according to treatment modalities. RESULTS: Of the 1610 patients with pancreatic cancer who underwent resection, 1346 (83·6 per cent) were diagnosed with recurrent pancreatic cancer. Recurrence was locoregional in 366 patients (27·2 per cent), distant multifocal in 251 (18·6 per cent), distant isolated in 188 (14·0 per cent), locoregional plus distant in 153 (11·4 per cent) and peritoneal seeding in 388 (28·8 per cent). Of the 1346 patients with recurrence, 197 (14·6 per cent) had isolated recurrence; of these, 48 (24·4 per cent of all isolated recurrences; 3·6 per cent of all recurrences) underwent resection. Median survival of the 197 patients after diagnosis of isolated recurrence was 14·7 months; it was longer in patients who underwent surgical resection than among those treated non-surgically (23·5 versus 12·0 months; P = 0·014). Multivariable analysis showed that chemotherapy and resection for recurrence were associated with better prognosis. Median survival after recurrence was longest in the 23 patients with isolated pulmonary recurrence (33·3 months). Survival after recurrence was better in patients who underwent resection of isolated recurrence in the remnant pancreas (median 28·0 versus 12·0 months, P = 0·010) and lung (median 36·5 versus 9·5 months; P = 0·010) than in those who did not undergo resection. CONCLUSION: Surgical resection may be considered an option for treatment of patients with isolated recurrent pancreatic cancer.

Beam characterisation of the KIRAMS electron microbeam system.

An electron microbeam system has been installed at the Korea Institute of Radiological and Medical Sciences (KIRAMS) for use in radiation biology studies. The electron beam is produced from a commercial electron gun, and the beam size is defined by a 5 microm diameter pinhole. Beam energy can be varied in the range of 1-100 keV, covering a range of linear energy transfer from 0.4 to 12.1 keV microm-1. The micrometer-sized electron beam selectively irradiates cells cultured in a Mylar-bottomed dish. The positioning of target cells one by one onto the beam exit is automated, as is beam shooting. The electron beam entering the target cells has been calibrated using a Passivated Implanted Planar Silicon (PIPS) detector. This paper describes the KIRAMS microbeam cell irradiation system and its beam characteristics.

Kinetics of adsorption of proteins at interfaces: role of protein conformation in diffusional adsorption.

To elucidate the role of protein conformation in the kinetics of adsorption at interfaces, seven structural intermediates of bovine serum albumin were prepared and their adsorption at the air/water interface was studied. Molecular area calculations indicated two distinct molecular processes, the first being the creation of an area, delta A1, for anchoring the molecule during the initial phase of adsorption and the second being the delta A2 cleared during subsequent reorientation and rearrangement of adsorbed molecules at the interface. The delta A1 values for all the albumin intermediates were the same, indicating that the initial work pi delta A1 needed to anchor the molecule at the interface was independent of solution conformation of the protein. Unlike delta A1, delta A2 exhibited a bell-shaped relationship with the extent of refolded state of the intermediates. Calculation of diffusion coefficients indicated that greater the unfolded state of the albumin intermediate, the greater was the diffusion coefficient. It is shown that the simple diffusion theory is inadequate to explain quantitatively the kinetics of protein adsorption. Specific, conformation-dependent, solute-solvent and solute-interface interactions also seem to influence the kinetics of adsorption of proteins.

Nucleotide sequence of levansucrase gene (levU) of Zymomonas mobilis ZM1 (ATCC10988).

The extracellular levansucrase gene (levU) was cloned from the genomic DNA of Zymomonas mobilis ZM1 and the nucleotide sequence of the levU structural gene was determined. The 3.1 kb EcoRV-polylinker fusion DNA fragment containing the levU gene had an open reading frame of 1272 bps and the deduced amino acid sequence was 423 residues long with a molecular weight of 46,725. Although this protein exhibited little similarity with other known levansucrases, several well-conserved regions were observed (1-5 regions).

Nucleotide and derived amino acid sequences of an extracellular sucrase gene (invB) of Zymomonas mobilis ZM1 (ATCC10988).

DNA sequence analysis of a previously cloned 4.5 kb DNA fragment showed that the extracellular sucrase gene (invB) of Zymomonas mobilis was located in the 155 bp downstream of levansucrase gene (levU). The invB gene had an open reading frame of 1242 bp and the deduced amino acid sequence was 413 residues with a molecular weight of 46,107. The translated sequence of Z. mobilis invB was in good agreement with the 10 N-terminal amino acid residues determined by amino acid sequencing. The amino acid sequence of sucrase showed low similarity with that of other sucrases, but higher similarity with that of levansucrases.

Effects of yeast (Saccharomyces cerevisiae) cell components on growth performance, meat quality, and ileal mucosa development of broiler chicks.

An experiment was conducted with 240, 1-d-old, male broilers to investigate the effects of Saccharomyces cerevisiae (SC) cell components on the growth performance, meat quality, and ileal mucosa development. There were 4 dietary treatments, each consisting of 6 replicates. Whole yeast (WY), SC extract (YE), and SC cell wall (CW) were added at 0.5, 0.3, and 0.3%, respectively, to the control starter and finisher diets. From 0 to 3 wk of age, a lower feed/gain ratio (P < or = 0.05) was observed with CW, whereas the WY-fed birds at 4 to 5 wk of age showed a lower feed/gain ratio compared with the control. From 0 to 5 wk of age, WY and CW gave higher BW gains than did the control. The shear force of raw drumstick decreased in the WY treatment relative to the control, and YE and CW treatments were intermediate. The shear forces in cooked breast and drumstick in treatments WY and YE decreased when compared with the control. The amount of 2-thiobarbituric acid-reactive substances (TBARS) in the breast meats of WY, YE, and CW were lower than the control at 10 d of incubation. In raw drumstick meats, TBARS values were lower in treatments WY and YE than that of the control at 6 and 10 d of incubation. At 10 d of incubation, skins from YE and CW treatments had lower TBARS values than did the control. Villus height was greater in WY and CW compared with those in control and YE. No differences were found in crypt depth among the 4 treatments. The villus height/ crypt depth ratios in WY and CW were greater than those of the control and YE. It could be concluded that dietary yeast components, such as WY or CW supplementation improved growth performance. Meat tenderness could be improved by the WY or YE. Both YE and CW had oxidation-reducing effects. Yeast cell wall may improve ileal villus development.

Transcriptional analysis of levU operon encoding saccharolytic enzymes and two apparent genes involved in amino acid biosynthesis in Zymomonas mobilis.

Extracellular levansucrase (LevU) and sucrase (InvB) are two of the three saccharolytic enzymes involved in the sucrose metabolism of Zymomonas mobilis. The levU and invB genes were clustered with a 155bp interval on the chromosome. Both genes were transcribed constitutively at the basal level and the transcription of both genes was induced significantly when sucrose was added to the medium. These genes were transcribed as a bicistronic mRNA and the expression was modulated by a single promoter, which is located upstream of the levU gene. The transcriptional initiation site was mapped to -64bp from the translation start site of levU gene. These results indicated that two genes are most likely to constitute an operon. The glk operon, which encodes four glycolytic enzymes, was located close to the levU operon on the chromosome. Two apparent ORFs (ORF3 and 4) were found at the intervening sequence located between the glk and levU operons. These ORFs were transcribed divergently and showed high homology at the amino acid level with the bacterial global regulatory protein (Lrp) and aspartate racemase.

Secretory production of Arthrobacter levan fructotransferase from recombinant Escherichia coli.

Levan fructotransferase (LFTase) from Arthrobacter ureafaciens K2032 was expressed with N-terminal fusion of a LacZ-derived secretion motif (TMITNSSSVP) using the lac promoter system in recombinant Escherichia coli JM109 [pUDF-A81]. In flask cultures, recombinant enzyme activity was detected in culture media, and sequence analysis of N-terminal residues showed that about 40% of the extracellular recombinant LFTase had an authentic N-terminus. In a fed-batch bioreactor containing recombinant E. coli at high cell concentrations (OD(600)>200), the extracellular LFTase accumulated to 46000 U ml(-1) (approximately 2.0 g l(-1)) which was almost 40% of total (intra- and extracellular) recombinant LFTase. The synthesized recombinant enzyme was secreted soon after gene expression was induced by IPTG. Prolonged high secretion caused cell lysis and growth inhibition during the production phase in fed-batch cultures. When lactose was added by continuous feed mode, the secretion of recombinant LFTase and hence the cell lysis were significantly delayed in spite of the increased synthesis level. Therefore the induced cell culture of recombinant E. coli could grow up to a much higher cell concentration with continuing recombinant enzyme synthesis. In the case of the controlled feed of lactose, the maximum activities (U ml(-1)) of total and extracellular LFTase were nearly 100% and 70% higher, respectively.

Molecular cloning of a gene encoding the thermoactive levansucrase from Rrahnella aquatilis and its growth phase-dependent expression in Eescherichia coli.

A levansucrase gene (lsrA) from Rahnella aquatilis ATCC33071 was isolated from a genomic library and the nucleotide sequence of the lsrA structural gene was determined. lsrA is composed of 1248 bp and encodes 415 amino acid residues with a calculated molecular mass of 45.9 kDa. Although the amino acid sequence of lsrA gene showed good conservation with the sequences of reported levansucrases and of the conserved regions thought to be implicated in the enzyme activity, comparison of the deduced amino acid sequences certified the dissimilarity of the proteins from Gram-negative and Gram-positive bacteria. The lsrA gene was expressed from its own promoter in Escherichia coli in an active form. The lsrA expression in E. coli-pRL1CPR was affected by the growth phase of cells: it was repressed in the early phase of growth, but was significantly stimulated during the entrance of cells into the late phase of growth. The growth-phase-dependent fashion of lsrA expression was altered in a constitutive-like fashion by the deletion of an upstream region of lsrA (pNd137), suggesting that the growth-phase dependent expression of lsrA was mediated by the deleted upstream region.

A case of disseminated extrahepatic hepatocellular carcinoma after US-guided biopsy and percutaneous ethanol injection therapy.

A case of disseminated extrahepatic hepatocellular carcinoma (HCC) occurring after ultrasound (US)-guided biopsy and percutaneous ethanol injection therapy is presented. A 72-year-old man with hepatitis-C-virus-related cirrhosis underwent percutanous ethanol injection therapy (PEIT) two times with complete remission: the first for moderately-differentiated HCC in segment six (S6), and the second for well-differentiated HCC in another part of S6. Imaging studies including carbon dioxide (CO(2))-US angiography, incremental computed tomography, and dynamic magnet resonance imaging showed that both HCCs were hypovascular. Twenty-one months after the first PEIT and 7 months after the second, a 5.5x4.5 cm extrahepatic mass interfaced with S6 of the liver was detected by imaging studies. The patient underwent surgery for extrahepatic HCC. Grossly, the main tumor was 5.5x4.5 cm with capsule and septum; the disseminated tumors were detected on the surface of the liver, including the right diaphragm and the falx ligamentosa. Histologically, it was moderately- to poorly-differentiated HCC, which, although not attributed to direct track seeding, was suspected of being induced by the percutaneous US-guided biopsy procedure or by PEIT, irrespective of a hypovascular tumor. Further studies may provide insight into the risk factor engendered by these procedures.

Redirection of carbon flux to lysine in a recombinant of Corynebacterium lactofermentum ATCC 21799 by limited supply of pantothenate.

To increase carbon flux to lysine, minimized production of amino acids that are biosynthetically related to lysine, for example, isoleucine and valine, is required. By limiting the supply of pantothenate, the precursor of coenzyme A, the carbon flux was redirected from isoleucine and valine to lysine in the recombinant of Corynebacterium lactofermentum ATCC 21799 containing the plasmid pGC77. The pGC77 contains hom(dr), thrB, and ilvA encoding feedback-deregulated homoserine dehydrogenase, homoserine kinase, and threonine dehydratase, respectively. At 250 microM of isopropyl-beta-d-thiogalactopyranoside, the recombinant (pGC77) produced lysine, valine, and isoleucine. Limiting the supply of pantothenate from 300 microg/l to 30 microg/l resulted in an increase in lysine (from 4.5 to 6.4 g/l) and decreases in valine (from 3.1 to 1.6 g/l) and isoleucine (from 0.9 to 0.3 g/l) production. The concentration of pyruvate was higher and that of acetate lower in the pantothenate-limited culture than in the control, suggesting that the limited supply of pantothenate delayed the conversion of pyruvate to acetyl-CoA. Increased availability of pyruvate by limiting the supply of pantothenate might favor the integration of pyruvate into the lysine branch. The results of this study are useful for the production of lysine with decreased concentrations of byproducts.

Exposure to volatile organic compounds for individuals with occupations associated with potential exposure to motor vehicle exhaust and/or gasoline vapor emissions.

Workers who work near volatile organic compounds (VOCs) source(s), motor vehicle exhausts and/or gasoline vapor emissions, are suspected to be exposed to highly-elevated VOC levels during their work-time. This study confirmed this suspicion and evaluated the work-time exposure VOCs for traffic police officers, parking garage attendants, service station attendants, roadside storekeepers and underground storekeepers, by measuring the concentrations of six aromatic VOCs in workplace air, or personal air and breath samples. For nearly all target VOCs, the post-work breath concentrations of the workers were slightly or significantly higher than the pre-work breath concentrations, depending on the compound and occupation. Furthermore, both the pre- and post-work breath concentrations of the workers showed elevated levels compared with a control group of college students. The post-work breath concentrations were significantly correlated with the personal air concentrations, while the pre-work breath concentrations were not. Smoking workers were not always exposed to higher aromatic VOC levels than non-smoking workers. The breath and personal air concentrations for all the target compounds were both higher for underground parking garage attendants than for ground-level parking attendants. For all the target compounds except toluene, storekeepers exhibited similar levels of exposure for all store types. Print shopkeepers recorded the highest toluene exposure.

Hepatitis B prevalence and infection control among dental health care workers in a community in South Korea.

OBJECTIVES: The objectives of this study were to investigate the prevalence of hepatitis B vaccine and use of infection control procedures by dental health care workers in Taegu, South Korea. METHODS: Information was obtained with a mailed questionnaire sent to 300 private dental practices. Surveys were received from 177 dentists, 104 dental hygienists, and 46 dental assistants. All dental health care workers were asked to donate a blood sample for analysis of hepatitis B surface antigen (HBsAg) and antibody (anti-HBs). RESULTS: Vaccination against hepatitis B virus was reported by 63 percent of the respondents. About 40 percent of all participants answered that they were anti-HBs positive, while another 43 percent did not know their status. About 89 percent of dentists reported that they wore a mask with all patients, while hygienists (13.6%) and assistants (13.0%) were less likely to do so. Reported use of gloves (4.5%) and protective eyewear (14%) with all patients was extremely low in every group. Among the 56 dentists who were tested for HBV markers, 23 did not receive the vaccine against hepatitis B, and 13 percent (3 of 23) were positive for HBsAg as carriers. CONCLUSIONS: About 37 percent (120 of 327) of dental health care workers surveyed in this study in Korea did not receive the vaccine against HBV infection. Basic barrier techniques to prevent cross-contamination were not being used consistently. Nationwide guidelines for barrier techniques and hepatitis vaccinations should be developed and disseminated to dental personnel.

Hepatic stellate cells induce immunotolerance of islet allografts.

Activated hepatic stellate cells (HSCs) possess strong immune inhibitory activity. The present study highlighted the protective role of HSCs in islet transplantation. Recipients were randomly divided into 4 groups: a diabetic group, an HSC-alone group, an islet-alone transplant group, and a cotransplant group. Graft survival was compared among the 4 groups. Serum transforming growth factor ß (TGFß), tumor necrosis factor α, interleukin-1ß, and interferon gamma expression levels were measured. The infiltration of lymphocytes was observed via hematoxylin and eosin staining, and immunohistochemical examinations were performed. Results showed that allogeneic HSCs protect islet allografts better than syngeneic HSCs. There was significant prolonged graft survival and a higher level of TGFß in the cotransplant group (P < .01). The infiltration of lymphocytes in the cotransplant group was notably less than in the islet-alone group (P < .01). The formation of desmin-positive HSC packages was detected in the cotransplant group. In conclusion, allogeneic HSCs can better prolong the survival of islet allografts by stimulating TGFß expression and forming a biological capsule around the graft.

Single-center experience with pancreas transplantation.

BACKGROUND: Recently improved patient and graft survivals, as well as decreased of postoperative morbidity have ushered in pancreas transplantation (PT) due to technical refinements as well as better immunosuppression and postoperative management. Herein we analyzed the outcomes of PT over a 19-year experiences at a single center. METHODS: All recipients who underwent deceased donor or living donor PT from July 1992 to July 2011 were enrolled in this study. We reviewed their medical records, including operative records, as well as clinical and laboratory findings. We analyzed graft and patient survival rates using the Kaplan-Meier method. RESULTS: One hundred fifty-three cases were performed between July 1992 and July 2011. The indication for PT was type I diabetes in 125 (81.7%), and type II diabetes in 28 (18.3%) patients. The pancreas donor was deceased in 139 (90.8%) and living in 14 cases (9.2%). The type of PT was simultaneous pancreas-kidney transplantation (n = 91, 59.5%), pancreas alone (n = 49; 32.0%), or pancreas after kidney (n = 13, 8.5%). Median follow-up was 43.0 months (range 0-228). At 1, 5, and 10 years overall patient survivals were 93.8%, 88.1%, and 85.1%, and graft survivals, 82.3%, 70.6%, and 64.6%, respectively. When we divided the deceased donor PT recipients into two groups according to when they underwent PT (up to 2005 [n = 54]) vs 2006 and later [n = 85]), the recent group showed significantly improved patient and graft survival rates (P < .001). With no difference between type I (n = 65) and type II (n = 20) patients (P = .159). CONCLUSION: Considering the improved quality of life and long-term patient survival, PT can be an effective treatment strategy in diabetic patients requiring insulin regardless of type of disorder.

Adult dual kidney transplantations obtained from marginal donors: two case reports.

Organ shortage has led us to use grafts from expanded criteria donors (ECD). Dual kidney transplantation (DKT) using organs from an ECD, which are not acceptable for single kidney transplantation (KT), may overcome the insufficient functioning nephron mass. We performed DKTs in two recipients, the first DKT to be reported from Korea. In case 1, the donor was a 36-year-old man with hypertension. The cause of his brain death was intracranial hemorrhage. He had no known underlying renal disease; his serum creatinine level was 4.2 mg/dL. Despite the relatively young age of the donor, a biopsy revealed mild interstitial fibrosis and tubular atrophy with moderate arteriolar narrowing. The recipient's postoperative course was uneventful over the 69-month follow-up; her last serum creatinine was 1.3 mg/dL. In case 2, the 80-year-old male donor with a history of hypertension had a normal creatinine. The donor biopsy revealed mild glomerular sclerosis, tubular atrophy, and interstitial fibrosis with moderate arteriolar narrowing. The recipient had undergone a previous KT 14 years previously on the right side of the abdomen, but had resumed dialysis 2 years previously due to chronic allograft nephropathy. There was no delayed graft function. At month 4 posttransplantation, lymphoceles were treated by fenestration. At 6-month follow-up, her creatinine was 1.0 mg/dL. In our experience with these two cases, DKT with ECD kidney grafts seemed to be a successful strategy to avoid poor graft outcomes and overcome the donor organ shortage. Further studies including histological criteria for DKT, should be performed to determine the safest means to utilize ECD grafts.

Effects of various plasticizers and nanoclays on the mechanical properties of red algae film.

UNLABELLED: To manufacture red algae (RA) film, we used various plasticizers such as glycerol, sorbitol, sucrose, fructose, and polypropylene glycol (PPG), and then determined the mechanical properties of the RA films. The tensile strength (TS), elongation at break (E), and water vapor permeability (WVP) of the films containing various plasticizers ranged between 0.43 to 9.10 MPa, 10.93% to 47.17%, and 1.28 to 1.42 ng m/m2sPa, respectively. RA films containing fructose as a plasticizer had the best mechanical properties of all the films evaluated. Incorporation of nanoclay (Cloisite Na+ and 30B) improved the mechanical properties of the films. RA film with 3% Cloisite Na+ had a TS of 10.89, while RA film with 30B had a TS of 10.85 MPa; these films also had better E and WVP values than the other RA films evaluated. These results suggest that RA/nanoclay composite films are suitable for use as food packaging materials. PRACTICAL APPLICATION: Edible RE/nanoclay composite films prepared in the present investigation can be applied in food packaging.

Application of Gelidium corneum edible films containing carvacrol for ham packages.

We prepared an edible film of Gelidium corneum (GC) containing carvacrol as an antimicrobial and antioxidative agent. The GC film containing carvacrol significantly decreased the WVP, while TS and %E values were increased, compared to the film without carvacrol. Increasing amounts of an antimicrobial agent increased antimicrobial activity against Escherichia coli O157:H7 and Listeria monocytogenes. Application of the film to ham packaging successfully inhibited the microbial growth and lipid oxidation of ham during storage. Our results indicate that GC film can be a useful edible packaging material for food products, and the incorporation of carvacrol in the GC film may extend the shelf life.

Comparison of remineralization effect of three topical fluoride regimens on enamel initial carious lesions.

OBJECTIVES: Some studies have been conducted to evaluate the effect of different topical fluoride regimens on the remineralization of initial carious lesions. This study was conducted to compare the effects of 3 topical fluoride treatments on the surface microhardness, fluoride uptake, and fluorescence lesion area in enamel. METHODS: Forty-eight bovine teeth were demineralized and subjected to one of the following treatments: (1) no treatment (control), (2) iontophoresis using 2% sodium fluoride solution, (3) 1.23% acidulated phosphate fluoride gel application, and (4) 5% sodium fluoride varnish application. Six persons continuously wore a mandibular removable appliance mounted with eight treated bovine teeth orally for 4 weeks, except while eating, sleeping, and brushing. Microhardness of enamel surfaces was measured using a digital microhardness tester. The fluoride concentration was analyzed using a fluoride electrode, and the fluorescence lesion area was calculated by confocal laser scanning microscopy. RESULTS: No significant differences in the microhardness were observed in response to the 3 fluoride regimens. The highest level of fluoride was observed in the APF gel group. APF gel group also showed significantly reduced fluorescence lesion areas compared to those of the control group. CONCLUSIONS: The fluoride regimens showed no difference in surface microhardness; although APF gel showed the best effects in terms of fluoride uptake and decrease in the fluorescence lesion area, its effects were not significantly different from those of fluoride varnish.