Increase in the capability of interleukin 2 gene-transduced renal cell carcinoma cells to induce cytotoxic lymphocytes.

The immunogenicity of human cancer cells transfected with interleukin 2 (IL-2) gene, a potent vaccine candidate, has not yet been fully investigated. Human renal cell carcinoma (RCC) cells transduced with human IL-2 gene (RCC-IL-2) were investigated in vitro for the capability to induce lymphokine-activated killer (LAK) or cytotoxic T lymphocyte (CTL) activity in peripheral blood mononuclear cells (PBMC) or tumor-infiltrating lymphocyte (TIL). The RCC-IL-2 cells stimulated PBMC to demonstrate LAK activity, and also stimulated autologous TILs to proliferate and exhibit cytotoxicity relatively restricted to autologous tumor cells. In contrast, both parental RCC and RCC transduced with neomycin gene alone failed to induce these activities. These results indicate that RCC-IL-2 cells are more potent than the other RCC cells with regard to inducing cytotoxic lymphocytes against autologous tumor cells.

Histopathological findings in the biopsied muscle of a juvenile type III glycogenosis.

We report a case of juvenile type III glycogenosis that was confirmed by histopathological and biochemical studies. The histopathological findings consisted of vacuoles, periodic acid-Schiff positive materials, type 2B fiber deficiency, mildly positive acid phosphatase reaction and intensely positive non-specific esterase reaction. It is suggested that the enzyme reactions may be related to membrane-bound sacs containing glycogen.

Subjective evaluations and objective measurements of the ischial-ramal containment prosthesis.

We examined 12 transfemoral amputees, 6 using the IRC socket and 6 the QL socket, to confirm whether the ischial-ramal containment (IRC) socket is truly superior to the quadrilateral (QL) socket. In subjective evaluation, the IRC group was significantly better in the total score and in items of comfort, that is, to sit on a chair and lumbar lordosis at heel off (Mann-Whitney test, P < 0.05), better but not significant in the items of comfortable to wear, comfortable to go up and down stairs, and truncal sway during stance phase. By computed tomography, the femur of the IRC group was kept in a position significantly more medial than that of the QL group (Mann-Whitney test, P < 0.05); but no significant difference in gluteal medial muscle atrophy ratios between the two groups was found (Mann-Whitney test, P > 0.05). By X-ray, the stump of the IRC group was maintained significantly more adducted during one foot standing on the prosthesis (Mann-Whitney test, P < 0.05), but the lateral force ratio during mid-stance of the IRC group was smaller, but not significantly, than that of the QL group. Physiological cost index (PCI), an indirect simple method for evaluating oxygen consumption of gait, had no significant difference between the two groups (Mann-Whitney test, P > 0.05), and a multiple regression analysis revealed that the stump length ratio and lateral force ratio during mid-stance were significant explanatory variables for predicting PCI (adjusted R square: 0.87, F-value: 11.85, P < 0.05). The results of this study have revealed that the advantage of the IRC socket is a tender feeling of the stump, but that the metabolic efficiency is not superior to the QL socket at the most comfortable speed.

Isokinetic strength of elbow extensor muscles correlates with race time in wheelchair half marathon racers.

It has been reported that grasping power and isometric muscle strength of elbow extensors in fine wheelchair racers were greater than the poor racers in the wheelchair full marathon. The purpose of the present study was to investigate the relationship between muscle strength of elbow extensors and flexors and the race time in wheelchair half marathon race. Four wheelchair half marathon racers who completed the half marathon division of the 16th Oita International Wheelchair Marathon (OIWM) in 1996 participated in the present study. The day before the race, all subjects reported to the training room and the isokinetic muscle strength of elbow extensor and flexor muscle groups was measured at angular speeds of 60 degrees, 120 degrees and 240 degrees/sec using the isokinetic dynamometer. There was a significant correlation between race time and isokinetic muscle strength of the elbow extensors at 60 degrees, 120 degrees and 240 degrees/sec, but not flexor muscles. Our findings suggest that increased muscle strength of elbow extensors may improve the race time in wheelchair half marathon race.

[A case report of ball variance of Smeloff-Cutter prosthetic valve].

A 37-year-old woman had undergone aortic valve replacement with Smeloff-Cutter prosthetic valve in 1967. She visited our hospital because of dyspnea and chest pain about 22 years after the operation. Severe aortic regurgitant murmur was audible and a chest X-ray demonstrated lung edema. A diagnosis was made of acute left heart failure due to prosthetic valve dysfunction, and emergency operation was performed. The Silastic ball was severely deformed and shrunken. Therefore, the ball was easily put off outside the cage. A St. Jude medical prosthetic valve was implanted. The postoperative course was uneventful.

[A case of ruptured aortic arch aneurysm into the lung].

Successful surgical treatment of aortic arch aneurysm ruptured into the left lung was reported. The patient was a 74-year-old man suffering from recurrent hemoptysis. Computed tomography and aortic angiography demonstrated a giant aortic arch aneurysm. Emergency operation was performed. Arch reconstruction by a Dacron graft was performed with hypothermic circulatory arrest. The post operative course was uneventful and there was no evidence of cerebral complication. In the emergency operation for ruptured aortic arch aneurysm, hypothermic circulatory is very useful method for cerebral protection.

[A case of pulmonary infarction secondary to subacute bacterial endocarditis with subpulmonary VSD].

A case of pulmonary infarction secondary to subacute bacterial endocarditis of pulmonary valve which is associated with subpulmonary VSD is presented. The jet stream of blood through the subpulmonary VSD made damage to the pulmonary valve, which may be one of the reasons why subacute bacterial endocarditis was associated with the subpulmonary VSD. Echocardiography of the right-sided valves will be very useful in order to detect the pulmonary valve endocarditis in congenital heart disease presenting with fever.

[Intrathoracic pacemaker implantation in children].

In order to minimize the complications, we introduced the intrathoracic implantation method since 1976. Until 1988, 12 children underwent this method. A pacemaker generator was exchanged in 8 patients, 12 times, because of battery exhaust. Compared with the conventional method (abdominal wall implantation), the complications such as electrode fracture, which was related to the implantation sites, were reduced. Furthermore it was very useful from the cosmetic viewpoint. Although an exchange of generator was very easily done at the first time, it was very difficult at the second time, due to rib fusion accompanying with children's growth.

[Surgical consideration of ruptured abdominal aortic aneurysms].

During the recent 18 and a half years, 30 cases of ruptured abdominal aortic aneurysm (including four cases of A-V fistula) were operated at Saiseikai Utsunomiya Hospital. In 26 cases, a conventional graft replacement was performed. In other four cases, axillo-bifemoral bypass (in the cases ruptured into the colon) or other methods were used. Overall operative mortality rate was 26.7%. However, during the last 9 years, operative results were improved (21.7%, 5 deaths out of 23 cases). Amount of intraoperative blood loss influenced the operative results greatly. Other operative risk factors included preoperative shock, preoperative severe cerebrovascular or cardiovascular complications, and postoperative thromboembolism. Factors of recent improvement in mortality included; establishment of emergency system which resulted in earlier operation after the patient's arrival at the hospital, use of occlusive balloon for bleeding control, heparin administration before the aortic clamp for preventing peripheral thromboembolism and introduction of autotransfusion system for reducing the amount of blood transfusion.

SU-E-I-91: Development of a Compact Radiographic Simulator Using Microsoft Kinect.

PURPOSE: Radiographic simulator system is useful for learning radiographic techniques and confirmation of positioning before x-ray irradiation. Conventional x-ray simulators have drawbacks in cost and size, and are only applicable to situations in which position of the object does not change. Therefore, we have developed a new radiographic simulator system using an infrared-ray based three-dimensional shape measurement device (Microsoft Kinect). METHODS: We made a computer program using OpenCV and OpenNI for processing of depth image data obtained from Kinect, and calculated the exact distance from Kinect to the object by calibration. Theobject was measured from various directions, and positional relationship between the x-ray tube and the object was obtained. X-ray projection images were calculated by projecting x-rays onto the mathematical three-dimensional CT data of a head phantom with almost the same size. The object was rotated from 0 degree (standard position) through 90 degrees in increments of 10 degrees, and the accuracy of the measured rotation angle values was evaluated. In order to improve the computational time, the projection image size was changed (512*512, 256*256, and 128*128). RESULTS: The x-ray simulation images corresponding to the radiographic images produced by using the x-ray tube were obtained. The three-dimensional position of the object was measured with good precision from 0 to 50 degrees, but above 50 degrees, measured position error increased with the increase of the rotation angle. The computational time and image size were 30, 12, and 7 seconds for 512*512, 256*256, and 128*128, respectively. CONCLUSIONS: We could measure the three-dimensional position of the object using properly calibrated Kinect sensor, and obtained projection images at relatively high-speed using the three-dimensional CTdata. It was suggested that this system can be used for obtaining simulated projection x-ray images before x-ray exposure by attaching this device onto an x-ray tube.

SU-E-J-26: Automated Estimation Method of Patient Setup Errors Using Simulated Portal Images for Prostate Cancer Radiotherapy.

PURPOSE: We developed a novel automated estimation method for patient setup errors based on simulated and real portal images for prostate cancer radiotherapy. METHODS: The estimation of patient setup errors in this study was based on a template matching technique with a cross-correlation coefficient and Sobel filter between the real portal image and localized pelvic template of reference image, which were DRR (digitally reconstructed radiography) images and simulated portal images. The simulated portal image was derived by projecting a CT image according to an inverse exponential power law of x-ray attenuation for a water-equivalent path length of each voxel of the CT image on each ray from a source to each pixel on the EPID (electric portal imaging device). A localized pelvic template of each patient in AP (anterior-posterior) or lateral view was automatically extracted from the DRR or simulated portal images by cropping a rectangular region, which was determined by using the mean pelvic template and four anatomical feature points. We applied the proposed method to three prostate cancer cases, and evaluated it using the residual error between the patient setup error obtained by proposed method and the gold standard setup error determined by two radiation oncologists. RESULTS: The average residual errors of the patient setup error for the DRR and simulated portal images were 0.79 and 1.26 mm in the left-right (LR) direction, 3.17 and 2.05 mm in the superior-inferior (SI) direction, 1.69 and 5.82 mm in the anterior-posterior (AP) direction, 3.84 and 6.94 mm in Euclidean distance (ED), respectively. If we used the simulated portal image for LR and SI directions and the DRR image for AP direction, the Euclidean distance was 3.22 mm. CONCLUSIONS: The proposed method has a potential to correctly estimate patient setup errors for prostate cancer radiotherapy.

SU-E-J-117: Computer-Assisted Verification of Accumulated Dose Distribution during the Treatment Time Based on Estimation of Four-Dimensional Dose Distribution Using an Electronic Portal Imaging Device.

PURPOSE: The accumulated dose distributions during the course of radiation treatment are substantially important for verifying whether treatment dose distributions are produced according to planned dose distributions. The purpose of this study was to develop a computer-assisted verification method of accumulated dose distribution during the irradiation of a tumor based on estimation of four-dimensional (4D) dose distribution using an electronic portal imaging device (EPID). METHODS: The 4D 'treatment' computed tomography (CT) images during the irradiation were estimated based on affine transformations including respiratory motions, which were derived by registration between a planning portal dose image and treatment portal dose dynamic image. Planning portal dose images were calculated from planning CT images and an algorithm for calculation of dose spatial distribution. Treatment portal dose images were estimated from EPID dynamic images obtained during a treatment time. The planning portal dose images were registered to the treatment portal dose images to obtain the affine transformation, which could include respiratory motion in a patient body. The CT images at a treatment time were determined by deforming the planning CT images using the affine transformation matrix. 4D dose distributions during a treatment delivery were obtained by applying a dose calculation algorithm to the 4D treatment CT images. Finally, accumulated dose distributions during the course of radiation treatment were verified with planned dose distributions. RESULTS: We applied the proposed method to EPID dynamic images of 2 lung cancer patients, and evaluated the difference in accumulated dose distribution between the plan and treatment using a gamma evaluation (3mm/3%). The average pass rate for 2 cases was 78.2%. CONCLUSIONS: The proposed method can be used for adaptively modifying the plan based on the dose discrepancy between the plan and treatment. This work was partially supported by Grant-in-Aid for Scientific Research (C) (22611011) and Okawa Foundation for Information and Telecommunications.

Disuse muscle atrophy of lower limbs in hemiplegic patients.

OBJECTIVE: To clarify the histopathologic findings from lower limb muscles in hemiplegic patients and determine whether the findings are related to the severity of paralysis or daily physical activity. DESIGN: Nonrandomized control trial. SETTING: Referral center. PATIENTS: Eight patients were selected from 21 hemiplegic persons who underwent a muscle biopsy, and the controls were four men who had no abnormal findings in their histopathology. MAIN OUTCOME MEASURES: Morphometric evaluations of bilateral vastus lateralis muscles on the involved (I-VL) and non-involved (N-VL) sides in eight hemiplegic subjects, five flexor hallucis longus muscles on the involved side (I-FHL), and vastus lateralis muscles of four controls (C-VL) were performed. Muscle fiber diameters were measured with an image analyzer, and atrophy factors, hypertrophy factors, and fiber type proportions were calculated based on the data. RESULTS: The morphometric measurements revealed that the hemiplegic patients had type 2 fiber atrophy, type 2B fiber atrophy, and type 2 fiber atrophy with type 1 fiber hypertrophy in the I-VL, N-VL, and I-FHL, respectively, and that the controls had no muscle fiber atrophy or hypertrophy. The muscle fiber atrophy in the hemiplegic patients was not related to the period after the onset, the severity of paralysis, or activities of daily living score but was related to daily physical activity. CONCLUSIONS: Although the hemiplegic patients had undergone rehabilitative treatments, which did not include muscle strengthening exercises, in a hospital without a board-certified doctor of rehabilitation medicine, a considerable amount of muscle atrophy was found characteristic of changes seen in disuse.

[Quality control of radioimmunoassay for TSH, LH, FSH, C-peptide, prolactin based on NIH-computer program].

As there has been no data available on the variation of RIA through a year, we assessed within kit and component of between assay variation of TSH, LH, FSH, C-peptide and PRL kit through a year (more than 12 sequential assays). The average of within kit variation was 6.9% (ranged from 4.7 to 9.8%) and that of component of between assay variation was 11.2% (ranged from 8.9 to 14.5%). These values were almost similar to those obtained for the within kit variation and component of between assay variation employing single lot of kit. These results warrant that quality of kits produced by manufacturers was homogeneous throughout the observation period.

Clinical evaluation of free thyroxine calculation from thyroxine and thyroxine binding globulin radioimmunoassays.

Free T4 calculation was performed based on the equation of the law of mass action between T4 and TBG assessed by routine radioimmunoassay. To examine the validity of this calculation, sera from normal subjects, from hypo- and hyperthyroid patients, from subjects with hereditary deficiency or increase in TBG, and those from uncomplicated pregnancy were included in the assay and the results were compared with those directly measured by radioimmunoassay with encapsulated antibody. Free T4 calculation on the sera described above was almost equal to the free T4 concentration measured directly and reflected clinical thyroid states. Thus, the proposed equation for the calculation of free T4 from total T4 and TBG radioimmunoassay is useful for clinical purposes as well as direct free T4 radioimmunoassay.

Spectral electromyographic fatigue analysis of back muscles in healthy adult women compared with men.

OBJECTIVE AND DESIGN: To investigate the difference in back muscle endurance between normal adult women and men using surface electromyographic (EMG) power spectral analyses. METHODS: Forty-five healthy subjects (22 men and 23 women) were studied during an unsupported trunk holding test for 120 seconds. Recording surface electrodes were placed over each erector spinae muscle at L1 level. OUTCOME MEASURES: Median frequency (MF), mean power frequency (MPF), and zero crossing rate (ZCR) were evaluated using the ME3000P Fast Fourier Transform spectrum analysis program. The rate of change was determined for each parameter during the test, and correlation was examined by Pearson's correlation. RESULTS: The negative slopes of all indices of back muscle fatigue were significantly steeper in men than in women. CONCLUSION: Our results indicated that the trunk holding test combined with EMG power spectral analysis of lumbosacral muscles is useful for the evaluation of fatigue performance of these muscles. Our results also showed a higher muscle endurance in healthy adult women than in men.

Acetylcholinesterase activity of developing muscles in the lower limb of the rat.

A cytochemical study of acetylcholinesterase was done in the lower limb of the prenatal rat and in the gastrocnemius muscle of the postnatal rat. Between 15 and 17 days of gestation, mesenchymal cells constituting the muscle primordia are characterized by the presence of enzyme activity in their rough endoplasmic cisterns and nuclear envelopes, while those involved in the formation of the neocapillary and cartilage do not show enzyme activity. This suggests that mesenchymal cells destined to myogenic cells actively produce acetylcholinesterase in a limited period, which may play a role in cellular aggregation and fusion during the muscular morphogenesis. Cytochemical findings as to extensive networks of secondary synaptic folds of the neuromuscular junctions and invaginations of the sarcolemma in the extrasynaptic regions are also illustrated in the differentiating gastrocnemius muscles.

Histochemical and immunological analyses of differentiating skeletal muscle fibers of the postnatal rat.

Fiber type differentiation as revealed by myosin ATPase activities and the immunological analysis of myosin light chains (MLC) by the Western blotting method were done on the postnatal rat soleus and extensor digitorum longus (EDL) muscles. In the soleus, type 1 (slow-twitch) muscle fibers gradually increase in percentage after postnatal day 10, and, in the EDL, the differentiation of type 2A and 2B (fast-twitch) muscle fibers is also pronounced between postnatal days 10 and 15. The present immunological analysis of MLC indicates that the antigenicity of Lc1S becomes more intense with a rapid decrease in antigenicity of Lc2F from postnatal day 7 in the soleus, while the antigenicity of Lc1F becomes noticeable during the same period in the EDL. These results suggest that the differentiation of slow-twitch fibers is mainly due to that of Lc1S in the soleus and the differentiation of fast-twitch fibers is mainly due to that of Lc1F in the EDL.