Early recurrence after surgical resection in patients with pathological stage I non-small cell lung cancer.

INTRODUCTION: Early recurrence is observed even in patients who undergo complete resection and had pathological (p-) stage I. Therefore, we focused on early recurrence, and attempted to elucidate the relationship between early recurrence and clinicopathological factors. METHODS: Between May 1993 and December 2005, 1201 patients with non-small cell lung cancer (NSCLC) underwent surgical treatment at our institution. Of these, 402 patients who underwent complete resection and had p-stage I NSCLC were retrospectively analyzed for clinicopathological factors. Patients were divided into four groups according to the period between surgery and recurrence (R): no recurrence (NR, n = 331), late recurrence (LR, n = 28, R > 2 years), intermediate recurrence (IR, n = 22, 1 year < R < or = 2 years), and early recurrence (ER, n = 21, R < or = 1 year). RESULTS: The overall 5-year survival rate for patients with p-stage I was 79.9 %. The overall 5-year survival rates were 91.0 %, 55.6 %, 17.1 %, and 7.5 % for the NR, LR, IR, and ER group, respectively. Preoperative high CEA level, lymphatic permeation, and pleural invasion were proven to be independent factors for overall recurrence. Moreover, multivariate analysis showed that preoperative CEA level, pathological T factor, lymphatic permeation, vascular invasion, and pleural invasion influenced early recurrence within one year. CONCLUSIONS: The present study demonstrated that preoperative CEA level, pathological T-factor, lymphatic permeation, vascular invasion, and pleural invasion were independent prognostic factors for early recurrence within one year, even in patients with pathological stage I. In patients with these factors, adjuvant therapy may be indicated since this may improve their survival.

Morbidity in video-assisted thoracoscopic lobectomy for clinical stage I non-small cell lung cancer: is VATS lobectomy really safe?

OBJECTIVE: The objective of this study was to compare video-assisted thoracoscopic lobectomy (VATS lobectomy) with standard thoracotomy in terms of morbidity and mortality. PATIENTS AND METHODS: Two-hundred and forty-nine consecutive patients with clinical (c) stage I non-small cell lung cancer who underwent surgery between 1999 and 2003 were retrospectively analyzed. All of the patients underwent surgical resection that was at least as extensive as lobectomy. VATS lobectomy was performed in 73 patients, and thoracotomy in 176 patients. RESULTS: The clinical stages were stage IA in 151 (60.6 %), and stage IB in 98 (39.4 %), and the pathological stages were I in 206 (82.7 %), II in 16 (6.4 %), and III in 27 (10.9 %). The mean operation time was 291 minutes for VATS and 215 minutes for thoracotomy ( P = 0.0 042). The mean blood loss was 160 ml and 191 ml ( P = 0.2 738), respectively. Mortality was 1.4 % (1/73) in the VATS group, and 2.3 % (4/176) in the thoracotomy group ( P = 0.6 438). Morbidity was 19.2 % (14/73), and 24.4 % (44/176), respectively ( P = 0.1 315). Air leakage was the most frequent complication. Anastomotic leakage was found in four patients who underwent thoracotomy. The incidence of pulmonary vessel injury was 8.2 % in the VATS group and 1.7 % in the thoracotomy group ( P = 0.0 361). While pulmonary vessel injury was observed frequently in the intermediate part of the study period, the incidence decreased in the late period. CONCLUSIONS: Pulmonary vessel injury, longer operation times, and greater blood loss have been frequently observed with VATS lobectomy. Proficiency is required to perform VATS lobectomy, and the procedure should be performed by a well-trained surgeon as indicated by the results of this study.

Cyclosporine enhances alpha1-adrenoceptor-mediated nitric oxide production in C6 glioma cells.

The present study was aimed at elucidating the effect of cyclosporine on phenylephrine-evoked nitric oxide (NO) production in C6 glioma cells using direct electrochemical NO monitoring. Phenylephrine (0.1-10 microM) dose-dependently stimulated NO production (0.8-12.9 microM) and this was blocked by NO synthase inhibitor, prazosin, Ca2+-depletion and Xestospongin C (a blocker of the inositol 1,4,5-trisphosphate (IP3) receptor), suggesting that the alpha1-adrenoceptor signaling pathway mediates NO production in C6 cells. Cyclosporine (approximately 10 microM) failed to evoke NO production but increased phenylephrine-evoked NO production by 20-120% of phenylephrine alone in a dose-dependent manner (1-5 microM). Xestospongin C, at a concentration which showed no effect on phenylephrine-induced NO production, significantly inhibited the cyclosporine-enhanced phenylephrine response. This finding suggests that cyclosporine may increase phenylephrine-induced NO production by accelerating IP3 receptor function in the alpha1-adrenoceptor signaling pathway in C6 cells. This enhanced NO production in glial cells may be operative for the occurrence of cyclosporine neurotoxicity including convulsions and encephalopathy.

Identification by gene deletion analysis of a regulator, VmsR, that controls virginiamycin biosynthesis in Streptomyces virginiae.

Virginiae butanolide (VB)-BarA of Streptomyces virginiae is one of the newly discovered pairs of a butyrolactone autoregulator and a corresponding receptor protein of Streptomyces species and regulates the production of the antibiotic virginiamycin (VM) in S. virginiae. The gene vmsR was found to be situated 4.7 kbp upstream of the barA gene, which encodes the VB-specific receptor. The vmsR product was predicted to be a regulator of VM biosynthesis based on its high homology to some Streptomyces pathway-specific transcriptional regulators for the biosynthetic gene clusters of polyketide antibiotics, such as Streptomyces peucetius DnrI (47.5% identity, 84. 3% similarity), which controls daunorubicin biosynthesis. A vmsR deletion mutant was created by homologous recombination. Neither virginiamycin M(1) nor virginiamycin S was produced in the vmsR mutant, while amounts of VB and BarA similar to those produced in the wild-type strain were detected. Reverse transcription-PCR analyses confirmed that the vmsR deletion had no deleterious effects on the transcription of the vmsR-surrounding genes, indicating that VmsR is a positive regulator of VM biosynthesis in S. virginiae.

Identification of an AfsA homologue (BarX) from Streptomyces virginiae as a pleiotropic regulator controlling autoregulator biosynthesis, virginiamycin biosynthesis and virginiamycin M1 resistance.

Virginiae butanolide (VB)-BarA of Streptomyces virginiae is one of the newly discovered pairs of a gamma-butyrolactone autoregulator and the corresponding receptor protein of the Streptomyces species, and has been shown to regulate the production of antibiotic virginiamycin (VM) in S. virginiae. A divergently transcribed barX gene is situated 259 bp upstream of the barA gene, and the BarX protein has been shown to be highly homologous (39.8% identity, 74. 6% similarity) to S. griseus AfsA. Although AfsA is thought to be a biosynthetic enzyme for A-factor, another member of the family of gamma-butyrolactone autoregulators, the in vivo function of S. virginiae BarX was investigated in this study by phenotypic and transcriptional comparison between wild-type S. virginiae and a barX deletion mutant. With the same growth rate as wild-type S. virginiae on both solid and liquid media, the barX mutant showed no apparent changes in its morphological behaviour, indicating that barX does not participate in morphological control in S. virginiae. However, the barX mutant became more sensitive to virginiamycin M1 than did the wild-type strain (minimum inhibitory concentration, 50 microgram ml-1 compared with > 200 microgram ml-1) and exhibited reduced VB and VM production. The VM production was not restored by exogenous addition of VB, suggesting that BarX per se is not a biosynthetic enzyme of VBs but a pleiotropic regulatory protein controlling VB biosynthesis. DNA sequencing of a 5.6 kbp downstream region of barX revealed the presence of five open reading frames (ORFs): barZ, encoding a BarB-like regulatory protein; orf2, encoding a Streptomyces coelicolor RedD-like pathway specific regulator; varM, encoding a homologue of ATP-dependent transporters for macrolide antibiotics; orf4, encoding a homologue of beta-ketoacyl ACP/CoA reductase; and orf5, encoding a homologue of dNDP-glucose dehydratase. Reverse transcription polymerase chain reaction (RT-PCR) analyses of the downstream five genes together with those of the three upstream genes (barA, barB, encoding a regulatory protein; and varS, encoding a virginiamycin S specific transporter) revealed that, in the barX mutant, the transcriptions of barZ, orf2, varM and orf5 were completely repressed and those of barB and varS were derepressed. Because free BarA (BarA in the absence of VB) in wild-type S. virginiae represses the transcription of bicistronic barB-varS operon through binding to a specific DNA sequence (BarA-responsive element, BARE) overlapping the barB transcriptional start site, the derepression of barB-varS transcription in the barX mutant suggested that the in vivo function of BarA was impaired by the lack of BarX protein. Gel-shift assays revealed that BarA easily lost its DNA-binding activity in the absence of BarX but that the defect was restored by the presence of recombinant BarX as a fusion with maltose-binding protein (MBP-BarX), whereas MBP-BarX itself showed no DNA-binding activity, indicating that BarX is likely to be a co-repressor of BarA, enforcing the DNA-binding activity of BarA through protein-protein interactions.

Blasticidin A as an inhibitor of aflatoxin production by Aspergillus parasiticus.

Blasticidin A, an antibiotic, showed strong inhibitory activity toward aflatoxin production by Aspergillus parasiticus. Its structure was characterized by NMR and chemical degradation experiments as 1, which is a tetramic acid derivative with a highly oxygenated long alkyl chain similar to aflastatin A (2). Absolute configurations of the eight chiral centers at C-4, 6, 31, 32, 33, 34, 35 and 37 of 1 were chemically determined. Blasticidin A almost completely inhibited aflatoxin production at 0.5 microM.

Blasticidin A derivatives with highly specific inhibitory activity toward aflatoxin production in Aspergillus parasiticus.

Blasticidin A (1), an antibiotic, has strong inhibitory activity toward aflatoxin production by Aspergillus parasiticus. We prepared some derivatives of 1 and examined their biological activities. Among them, derivatives 3 and 4 without the tetramic acid moiety of 1 maintained inhibitory activity toward aflatoxin production, but did not show antifungal activity or toxicity. RT-PCR experiments indicated that derivatives 3 and 4 as well as 1 significantly reduced the expression of genes encoding aflatoxin biosynthetic enzymes (pksA, ver-1 and omtA) and a regulatory gene (aflR) in A. parasiticus. These results suggested that derivatives 3 and 4 can inhibit aflatoxin production more specifically than 1 by inhibiting an early step prior to the expression of aflR in the pathway of aflatoxin biosynthesis.

Direct and continuous electrochemical measurement of noradrenaline-induced nitric oxide production in C6 glioma cells.

1. Nitric oxide (NO) production in C6 glioma cells was directly monitored in real time by electrochemical detection with a NO-specific biosensor. 2. We present here the first direct evidence that noradrenaline elicits long-lasting NO production in C6 cells pretreated with lipopolysaccharide and interferon-gamma, an effect blocked by NG-monomethyl-L-arginine, a NO synthase inhibitor. 3. This direct electrochemical measurement of glia-derived NO should facilitate our understanding of the kinetics of glial signaling in glia-glia and glia-neuron networks in the brain.

[Questionnaire of cryopreserved allograft valves in Kyushu and Yamaguchi area].

Japanese Society of Cryopreserved Thoracic Tissue Implantation was recently set up. Cryopreserved allograft valves are about to pervade in Japan. To clarify the interest, demands and supply of cryopreserved allograft valve in the area of Kyushu and Yamaguchi, we performed questionnaire investigation regarding this issue. Collection rate of this questionnaire was 87.5% (35/40 hospitals). Ninety-seven percent of the hospitals answered that they were interested in cryopreserved allograft. Ninety-four percent of the hospitals answered that they did not ethically hesitate to use cryopreserved allograft. Ninety-one percent of the hospitals hoped to perform cardiac surgery using allograft aortic valve if allograft is available. With respect to securing donors of allograft, two-third of the hospitals did not decide whether they could be involved in obtaining donors of allograft. As the number of the cadaver kidney donors is about 20 per year in the area of Kyushu and Yamaguchi, shortage of donors of allograft valve is anticipated.