Impact of hepatic lymph node metastasis on survival of patients with synchronous resectable or unresectable liver metastases of colorectal cancer.

BACKGROUND: The goals of this retrospective study were to comprehensively evaluate the impact of hepatic lymph node (HLN) involvement on survival in patients with synchronous resectable or unresectable liver metastases from colorectal cancer and to highlight how to deal with such cases in the light of recent advances in chemotherapy. METHODS: The impact of HLN involvement on survival, along with various clinical, pathological, and therapeutic factors, was retrospectively evaluated in 61 patients with synchronous liver metastases from colorectal cancer (resectable, 26; unresectable, 35), undergoing resection of the primary tumor and histopathological evaluation between July 2000 and April 2008. RESULTS: The proportion with HLN metastasis was 11.5 % in resectable cases and 28.6 % in unresectable cases. On multivariate analysis using the Cox proportional hazards model, HLN metastasis (P < 0.001), along with non-resection of hepatic lesions (P < 0.001), larger metastatic tumor volume (P < 0.001), non-use of oxaliplatin-based chemotherapy (P < 0.001), involvement of 4 or more regional lymph nodes (P < 0.001), and excessive lymphatic invasion (P = 0.02), was identified as an independent risk factor for shorter survival. CONCLUSIONS: To establish a new therapeutic strategy for synchronous liver metastasis of colorectal cancer, the HLNs should be examined histologically in patients undergoing resection of their primary colon and rectal cancer.

A simple and safe technique for performing single-port laparoscopic resection of appendiceal mucocele.

We report a new method of performing single-port laparoscopic surgery for appendiceal mucocele. The key points of our technique are placing a 3/4 circumferential skin incision with multiple radial splits on the confine of the umbilicus, use of a "home-made" multichannel port system, and trimming the skin incision straight through the confine of the umbilicus at the time of wound closure. A 65-year-old woman with appendiceal mucocele, 80 mm in diameter, successfully underwent ileocecal resection by this procedure. She remains in good health without any wound complications 8 months postoperatively.

Curative colectomy via minilaparotomy approach without utilizing specific instruments.

BACKGROUND: This study evaluated the need for specific instruments when performing a curative resection of colon cancer via a minilaparotomy approach, which has been reported to be a minimally invasive alternative to a laparoscopic approach. METHODS: The feasibility, safety, and early oncological outcome were compared among 73 patients (first group), in whom a curative resection of colon cancer was performed via a minilaparotomy (skin incision < or =7 cm) utilizing specific instruments (North-bridge retractor system) between September 2002 and March 2005, and 94 patients (second group), in whom a similar procedure was performed without utilizing specific instruments between April 2005 and October 2007. RESULTS: The two groups did not differ significantly in terms of age, sex, body mass index, site of tumor, level of lymph node dissection, blood loss, UICC stage, number of harvested lymph nodes, incidence of postoperative complications, length of postoperative hospital days, or overall survival, although the frequency of prior abdominal surgery was higher (38.3 vs. 21.9%; P = 0.03) and the median operating time required for a standard lymph node dissection was shorter (120 vs. 135 min; P = 0.03) in the second group. CONCLUSION: With improved techniques and experience, specific instruments are not necessary for the performance of a curative colectomy via a minilaparotomy approach.

Resection of stage 0/I colon cancer via a circumferential periumbilical skin incision: relevance to single-incision laparoscopic surgery.

BACKGROUND: We have been performing curative resection of colon cancer via a minilaparotomy without utilizing any laparoscopic instruments as an alternative to laparoscopic-assisted approach. Based on our experiences and improved surgical techniques, we have devised a new method for performing resection of stage 0/I colon cancer via a circumferential periumbilical skin incision that is associated with better cosmesis than standard minilaparotomy. METHODS: The short- and long-term results of curative colectomy via a circumferential periumbilical skin incision without utilizing any laparoscopic instruments performed in selected patients with stage 0/I colon cancer between October 2003 and July 2004 were analyzed. RESULTS: There were 8 men and 2 women with a median age of 66.5 years (range 61-77 years). Their median body mass index was 22.4 kg/m(2) (range 21.1-27.7 kg/m(2)). Pathological stage according the TNM classification was stage 0 in 4 patients and stage I in 6 patients. Median operative time was 160.5 min (range 135-203 min), and median blood loss was 60 ml (range 5-330 ml). Postoperative complications consisted of seroma in two patients and small bowel obstruction in one patient. After a median follow-up period of 5.7 years, there were no recurrences or wound complications. CONCLUSION: Curative colectomy via a circumferential periumbilical skin incision seems oncologically safe, yields satisfactory cosmetic results, and may provide an alternative to single-incision laparoscopic surgery in selected patients with colon cancer.

A clinical and ultrasonographic study of risk factors for elbow injury in young baseball players.

PURPOSE: To determine the risk factors for elbow injury and its association with glenohumeral internal rotation deficit among young baseball players. METHODS: 229 baseball players aged 9 to 14 (mean, 11) years completed a self-administered questionnaire with items related to years of playing baseball, hours of training per weekday, days of training per week, and past and present experience of elbow pain. Two orthopaedic surgeons measured the range of motion of both shoulders and elbows. Another 2 orthopaedic surgeons performed ultrasonography to detect any elbow abnormality such as fragmentation of the medial epicondylar apophysis and osteochondritis dissecans of the capitellum. Using univariate and multivariable analyses, participants with or without elbow abnormality were compared to determine the risk factors for elbow abnormality. RESULTS: Elbow abnormality was detected in 100 of the participants and comprised osteochondritis dissecans of the capitellum (n=18) and fragmentation of the medial epicondylar apophysis (n=82). Elbow abnormality was associated with being a pitcher, past and present experience of elbow pain, loss of elbow extension, and the side-to-side internal rotation difference. The 100 participants with elbow abnormality were stratified into symptomatic (n=57) or asymptomatic (n=43) of elbow pain. Those with elbow abnormality and elbow pain was associated with being a pitcher. CONCLUSION: Being a pitcher was a risk factor for both elbow abnormality and elbow pain. Nonetheless, 43% of baseball players with elbow abnormality were asymptomatic. The use of ultrasonography was effective in detecting elbow abnormality and enabling early treatment.

Effects of ganglioside GM1 on DNA synthesis in isolated nuclei and on the activity of DNA polymerase alpha derived from S-phase HeLa cells.

Ganglioside GM1 inhibited either DNA synthesis in isolated nuclei or the activity of DNA polymerase alpha fractionated from S-phase HeLa cells. The concentrations of GM1 necessary for 50% inhibition were about 5 microM and 10 microM for nuclei and DNA polymerase alpha, respectively. The GM1 inhibition of the enzyme activity was suppressed by the addition of 0.05% Triton X-100. Neither gangliotetraosylceramide (asialo-GM1) nor free N-acetylneuraminic acid inhibited the enzyme activity. These facts suggest that GM1, probably in the form of micelles, could influence the enzyme activity by behaving as a polyanionic macromolecule. The kinetic studies indicate that the GM1 inhibition of the enzyme activity was not competitive with the substrate, deoxythymidine triphosphate, but rather with the template DNA. Binding of GM1 and DNA polymerase alpha was suggested by the cocentrifugation of GM1 and the enzyme fraction after their preincubation. It was also observed that other acidic glycolipids, i.e., brain sulphatide and seminolipid, also inhibited the enzyme activity, whilst neutral galactosylceramide did not. The inhibitory influences of these sulphate esters of glycolipids were, similarly to GM1, suppressed by the addition of 0.05% Triton X-100.

Alteration of ceramide monohexoside in human diploid fetal lung fibroblasts during cell aging.

Serially cultured human diploid fibroblasts have a finite lifetime in vitro, and this phenomenon was postulated as cellular aging. Neutral glycosphingolipids (GSLs) from human fetal lung-derived diploid fibroblast cell lines, WI-38 and TIG-1 cells, were studied during cellular aging. Both cell lines had at least four types of neutral GSLs. It was found that neutral GSLs changed with aging, the most conspicuous alteration being a 2-4-fold increase in the content of ceramide monohexoside. This change was invariably observed in either WI-38 or TIG-1 cells.

Minilaparotomy approach for colonic cancer: initial experience of 54 cases.

BACKGROUND: The early outcomes of minilaparotomy for resection of colonic cancer were evaluated. METHODS: In this study, 54 patients (34 Dukes' A, 15 Dukes' B, and 5 Dukes' C) successfully underwent curative resection of colonic cancer via minilaparotomy (skin incision, > or = 7 cm). The major exclusion criteria for this approach required a body mass index greater than 25 kg/m2, a tumor size exceeding 7 cm, a preoperative ileus, and tumor invading the adjacent organs. Patients (n = 54) who had undergone conventional open surgery before the introduction of this technique served as the control group by matching several clinicopathologic factors including body mass index. RESULTS: The passage of flatus (p < 0.01) and the beginning of oral intake (p = 0.02) were earlier, analgesic requirements were lower (p < 0.01), and postoperative serum C-reactive protein levels were lower in the minilaparotomy group (p < 0.01). The blood loss and frequency of postoperative complications did not differ between the groups. CONCLUSION: A minilaparotomy approach is a feasible, minimally invasive, and attractive alternative to conventional laparotomy for selected patients with colonic cancer.

Rat dorsal root ganglion gangliosides during early development until senescence.

The gangliosides of male rat dorsal root ganglia were studied during aging from the first day postnatally until senescence at 24 months. The ganglioside contents increased drastically until 12 months after birth and thereafter did not change considerably, and the increase pattern was in parallel with the increase of wet weight of the tissues. The major gangliosides of the dorsal root ganglia were GM3, LM1 (sialosyl-lactoneotetraosylceramide), unknown ganglioside X, GD1a, GD1b, GT1b and GQ1b. The most drastic changes in ganglioside composition were observed between the ages of postnatal day 1 and 1.5 months. The unknown ganglioside X (dominant at postnatal day I) decreased up to 1.5 months. In contrast, LM1, a minor ganglioside postnatal day 1, increased until 1.5 months of age. Except for these changes, the other gangliosides were present at almost constant ratios in the component profiles during aging until senescence.

Changes of mouse brain gangliosides during aging from young adult until senescence.

The brain gangliosides from young adult to senescent mice (BDF1 and C57BL/6) were studied. The total ganglioside concentrations of the whole brains were almost constant from young adulthood until the beginning of senescence, but decreased constant from young adulthood until the beginning of senescence, but decreased during senescence to about 80% of the constant level observed at the period before the beginning of senescence. In spite of the constancy of the ganglioside concentrations at the period before the beginning of senescence, the composition gradually changed, with an increase of GM1 and decreases of GD1b, GT1b and GQ1b. During the senescence, all of the gangliosides decreased in their concentrations, but GD1a, GT1b and GQ1b decreased to a markedly greater extent (GT1b greater than GD1a greater than GQ1b). The regional gangliosides in olfactory bulb, cerebrum cortex, cerebrum white matter, hippocampus, hypothalamus, cerebellum and medulla oblongata were compared between 3- and 30-month-old mice of both strains. Significant changes in ganglioside concentrations were observed in both strains in the cerebrum and the hippocampus. In the cerebrum white matter, cerebellum and medulla oblongata, GM1 and GM4 contents significantly increased in the senescent mice.

Age-related alteration of brain gangliosides in senescence-accelerated mouse (SAM)-P/8.

The senescence-accelerated mouse (SAM)-P/8 was examined with respect to changes in the content and composition of brain gangliosides during aging from juvenile to senescence. The gangliosides were compared with those of control mice, senescence-accelerated resistant mouse (SAM)-R/1. The ganglioside contents in the whole brains of SAM-P/8 and -R/1 were at almost constant level from 0.5 to 6 months, but decreased thereafter until senescence to about 80% of the levels reached at the younger ages. Upon aging, the ganglioside compositions changed with an increase of GM1, and decreases of GD1a, GD1b and GT1b in both strains (GT1b greater than GD1a greater than GD1b). A minor component, GM3 was two to four fold higher in the molecular distributions of the whole brain gangliosides of SAM-P/8 than those of -R/1 at any age examined throughout the life span. The regional gangliosides in olfactory bulb, cerebral cortex, hippocampus, hypothalamus, cerebellum, corpora quadrigemina region, brain stem and medulla oblongata were compared between the two strains at the age of three months. The ganglioside contents in the brain stem and medulla oblongata were lower in SAM-P/8 than -R/1, but there was no significant difference between the two strains in the other regions. As a minor component, GM3 was found to occur in a higher concentration in SAM-P/8 than -R/1 in all brain regions examined, except in the olfactory bulb where GM3 was detected as a major component with no difference in the distribution level between the two strains.

Frequent presence of anti-GQ1b antibody in Fisher's syndrome.

We used the enzyme-linked immunosorbent assay to investigate autoantibodies against the gangliosides GM1, GD1a, GD1b, GT1b, GD2, and GQ1b in sera from 16 patients with Fisher's syndrome. We found high anti-GQ1b antibody titers, mainly those of the IgG class, in the sera of 13 of these patients. The titers decreased with the clinical course of the illness. Moreover, anti-GQ1b antibody-positive patients had more severe ataxia of cerebellar type than the antibody-negative patients.

Lack of modifying effects of linolic acid hydroperoxides and their secondary oxidative products on combined 7,12-dimethylbenz[a]anthracene and 1,2-dimethylhydrazine-initiated mammary gland, ear duct and colon carcinogenesis in female Sprague-Dawley rats.

Effects of hydroperoxides, autoxidation products of linolic acid (HPO) and secondary oxidative products of HPO (SOP) (5% each in diet) were examined in female Sprague-Dawley rats. HPO and SOP administration was carried out during or subsequent to two injections of dimethylhydrazine (DMH) (40 mg/kg body wt s.c.), and a single i.g. dose of 7,12-dimethylbenz[a]anthracene (DMBA) (50 mg/kg body wt). No significant differences in the incidences of tumors in the mammary gland, colon, ear duct and hematopoietic system associated with HPO or SOP treatment were evident, during or after carcinogen exposure. The present results therefore indicate that the environmental contaminants, HPO and SOP, lack any potential for modification of mammary gland or colon carcinogenesis under the conditions of the investigation.

Age and cell density dependent changes of gangliosides in human diploid fibroblasts.

The gangliosides in human diploid fibroblasts--TIG-1, TIG-7, and IMR-90--were analysed at different cell densities at early and late passages to clarify the relationship between age and cell density dependent changes of the gangliosides. In early passages, the ganglioside concentrations increased with increase in cell density. At late passages, however, the concentrations were lower than those at the early passages either in the growing or confluent phase, and slightly increased with increase in cell density. The pattern of ganglioside compositions were apparently different between early and late passage cells either in growing or confluent state. In the early passages, GM3 and GD3 were major constituents, and GM2, GD1a, or the other more complex gangliosides were detected as minor components. With increase in cell density, the content of GM3 decreased, whereas GD3 and the others increased. At the late passages, however, GM3 was the major component, and GD3, GM2, or GD1a were minor, but the others were hardly detectable. The ganglioside pattern did not change with increase in cell density. Thus, the age-dependent changes of gangliosides could be distinguished from the cell density dependent alterations.

Ganglioside changes during cell aging in human diploid fibroblast TIG-1.

Gangliosides of human diploid fibroblast, TIG-1, derived from fetal lung were analyzed during cell aging. The major gangliosides of TIG-1 cells were GM3 and GD3. During cell aging, GM3 and other gangliosides were decreased or below detection level. Lipid-bound sialic acid per mg protein was 2 micrograms at the early, middle and late passages, but between the middle and late passage it was twofold higher than the other passages.

Prometaphase chromosomes in the tricho-rhino-phalangeal syndrome type I.

Prometaphase chromosome analysis was undertaken in a patient with familial tricho-rhino-phalangeal syndrome type I (TRPS-I). The patient had apparently normal chromosomes and produced counterevidence to part of Bühler's hypothesis. Thus, although some cases of typical TRPS-I may be derived from a deletion of 8q24.12, others might be caused by gene mutation or submicroscopic deletion involving the corresponding locus within the band 8q24.11----24.13.

Susceptibility effects of bone trabeculae. Quantification in vivo using an asymmetric spin-echo technique.

RATIONALE AND OBJECTIVES: The authors assessed the capability of magnetic resonance imaging in measuring bone mineral density in vivo. METHODS: Using the in-phase asymmetric spin-echo technique, the susceptibility effect (T2*susceptibility) was measured in lumbar vertebrae in vivo. Calcium density was measured with single energy quantitative computed tomography scan. The values of the susceptibility effect were correlated with calcium density. RESULTS: A statistically significant positive correlation was observed between signal loss due to susceptibility-induced inhomogeneity and the calcium density in the region of interest. The change in 1/T2*susceptibility per unit change in density was 0.114 seconds-1/mg/cm3. T2*susceptibility was 14.3 mseconds in volunteers and 17.4 mseconds in postoophorectomy patients. CONCLUSIONS: To some extent, quantification of bone density is possible using magnetic resonance imaging; however, the relatively wide dispersion of the susceptibility effect, plotted against the calcium density in the axial skeleton, indicates that other factors, such as the three-dimensional structure of bone trabeculae, may play important roles in determining magnetic resonance parameters.

Magnetoresistance of ferromagnetic tunnel junctions in the double-exchange model

We conduct a theoretical study of the temperature dependence of the spin polarization ( P) and the magnetoresistance (MR) ratio using the double exchange (DE) model for ferromagnetic tunnel junctions with half-metallic systems. It is shown that the strong exchange coupling in the DE model plays an important role in the temperature dependence of both P and the MR ratio; their values can be less than the maximum values expected for half-metallic systems at low temperatures, and the MR ratio decreases more rapidly than P with increasing temperature. The calculated results, however, indicate that the MR ratio may still be large at high temperatures near the Curie temperature.

Neuron-specific PGP9.5 expression in rat hair follicle development and cycle.

Protein gene product PGP9.5 is a neuron-specific ubiquitin C-terminal hydrolase. We found that it also has immunoreactivity in the hair follicle of the Wistar rat dorsal skin and its expression patterns change with the development and cycle. During the morphogenesis, the PGP9.5 was expressed in the hair germ and hair peg elongated from the epidermis, and became restricted in the outer root sheath as the development progressed. In catagen, however, the PGP9.5 was detected in the tailing epithelial strand of the regressing proximal follicle epithelium, and in the keratinocytes directly contacted with the club hair, but rarely in the outer root sheath. With the beginning of the anagen of the second hair follicle, the PGP9.5 was again expressed in the second hair germ, and in the keratinocytes surrounding the remaining club hair and of distal follicle of the first hair. These findings showed that PGP9.5 is not specific to the neuron but is also involved in the hair follicle, and should provide new insight into the development and regression of the hair follicle.

Collateral occurrence of deimination of keratins with differentiation of an immortalized newborn rat keratinocyte cell line cultured at air-liquid interface.

We devised a simple method to maintain an immortalized newborn rat keratinocyte cell line at the air-liquid interface using a tissue culture insert fitted with a microporous membrane. The cells formed stratified layers of flattened and anucleated cells resembling stratum corneum of the epidermis. Deiminated proteins, which are localized in the cornified layer of epidermis as the reaction products of peptidylarginine deiminase were detected immunohistochemically in the differentiated cells. Western blot analyses revealed that major deiminated proteins were type I keratins K10 and K14. Deiminated products of type II keratin K5 were found as minor components. Our observations show that deimination of keratins might be correlated with terminal differentiation of the immortalized keratinocyte cell line.