Comparison of neoadjuvant chemotherapy versus upfront surgery with or without chemotherapy for patients with clinical stage III esophageal squamous cell carcinoma.

Neoadjuvant chemotherapy (NAC) and chemoradiotherapy have been shown to extend postoperative survival, and preoperative therapy followed by esophagectomy has become the standard treatment worldwide for patients with esophageal squamous cell carcinoma (ESCC). The Japan Clinical Oncology Group 9907 study showed that NAC significantly extended survival in advanced ESCC, but the survival benefit for patients with clinical stage III disease remains to be elucidated. We compared the survival rates of NAC and upfront surgery in patients with clinical stage III ESCC. Consecutive patients histologically diagnosed as clinical stage III (excluding cT4) ESCC were eligible for this retrospective study. Between September 2002 and April 2007, upfront transthoracic esophagectomy was performed initially and, for patients with positive lymph node (LN) metastasis in a resected specimen, adjuvant chemotherapy using cisplatin and 5-fluororouracil every 3 weeks for two cycles was administered (Upfront surgery group). Since May 2007, a NAC regimen used as adjuvant chemotherapy followed by transthoracic esophagectomy has been administered as the standard treatment in our institution (NAC group). Patient characteristics, clinicopathological factors, treatment outcomes, post-treatment recurrence, and overall survival (OS) were compared between the NAC and upfront surgery groups. Fifty-one and 55 patients were included in the NAC and upfront surgery groups, respectively. The R0 resection rate was significantly lower in the NAC group than in the upfront surgery group (upfront surgery, 98%; NAC, 76%; P = 0.003). In the upfront surgery group, of 49 patients who underwent R0 resection and pathologically positive for LN metastasis, 22 (45%) received adjuvant chemotherapy. In the NAC group, 49 (96%) of 51 patients completed two cycles of NAC. In survival analysis, no significant difference in OS was observed between the NAC and upfront surgery groups (NAC: 5-year OS, 43.8%; upfront surgery: 5-year overall surgery, 57.5%; P = 0.167). Patients who underwent R0 resection showed significantly longer OS than did those who underwent R1, R2, or no resection (P = 0.001). In multivariate analysis using age, perioperative chemotherapy, depth of invasion, LN metastasis, surgical radicality, postoperative pneumonia, and anastomotic leakage as covariates, LN metastasis [cN2: hazard ratio (HR), 1.389; P = 0.309; cN3: HR, 16.019; P = 0.012] and surgical radicality (R1: HR, 3.949; P = 0.009; R2 or no resection: HR, 2.912; P = 0.022) were shown to be significant independent prognostic factors. In clinical stage III ESCC patients, no significant difference in OS was observed between NAC and upfront surgery. Although potential patient selection bias might be a factor in this retrospective analysis, the noncurative resection rate was higher after NAC than after upfront surgery. The survival benefit of more intensive NAC needs to be further evaluated.

Role of peroxynitrite and recombinant human manganese superoxide dismutase in reducing ischemia-reperfusion renal tissue injury.

BACKGROUND: In an acute kidney transplant rejection rat model, we demonstrated that manganese superoxide dismutase (MnSOD) activity was significantly reduced and MnSOD was nitrated by peroxynitrite (ONOO(-)), resulting in tissue injury. We examined whether tissue injury was reduced after external supplementation of recombinant human MnSOD in a rat renal ischemia-reperfusion injury model. METHODS: Male Brown-Norway rats underwent dissection of the right kidney. The animals were divided into 3 groups. The controls had the left renal blood vessels clamped for 90 minutes to induce ischemia, followed by reperfusion for 16 hours. In the intraperitoneal administration group, MnSOD was administered 30 minutes before ischemia and immediately before reperfusion. In the sham group, neither ischemia nor reperfusion was performed. After reperfusion, blood was collected, the left kidney was dissected and renal function and tissue injury were evaluated. RESULTS: Serum creatinine and K(+), blood urea nitrogen, and aspartate aminotransferase activity decreased significantly, whereas serum Na(+) and renal function improved in the MnSOD group compared with the control and sham groups. On hematoxylin and eosin staining, the histological score indicated that acute tubular necrosis was significantly reduced by MnSOD administration. Periodic acid-Schiff staining was absent in the nonadministration group, whereas it persisted in the MnSOD group. In the proximal renal tubules a large proportion of anti-nitrotyrosine staining was present before but absent after MnSOD administration. CONCLUSIONS: MnSOD administration improved renal function and reduced tissue injury. It may also reduce tissue injury in acute kidney transplant rejection and other tissue injuries caused by similar molecular mechanisms.

Generalized hyperpigmentation of the skin due to vitamin B12 deficiency.

A 49-year-old man presented with neurosis, hyperpigmentation of the skin, and depigmentation of the hair. On examination, hyperpigmentation was observed on the oral mucosa and the skin of the forearms, elbows, palmar creases and periunguinal area, knees, and feet. He had megaloblastic anemia with a low serum level of vitamin B12 due to malabsorption resulting from a gastrectomy 10 years previously. His hyperpigmentation was resolved with vitamin B12 supplementation. Histology showed an increase of melanin in the basal layer. In electron microscopic study, many melanosomes were observed in melanocytes and surrounding keratinocytes. We consider that the dominant mechanism of hyperpigmentation due to vitamin B12 deficiency is not a defect in melanin transport but is rather an increase in melanin synthesis.

An ultra premature baby of 290 g birth weight needed more than 500 mg/kg of calcium and phosphorus daily.

Ultrapremature babies accompanied by intrauterine growth retardation may require supplemental calcium and phosphorus far above the recommended doses.

Synthesis of gibbilimbols A-D, cytotoxic and antibacterial alkenylphenols isolated from Piper gibbilimbum.

Gibbilimbols A [(E)-4-(4-decenyl)phenol, 1], B [(E)-4-(3-decenyl)phenol, 2], C [(E)-4-(4-octenyl)phenol, 3] and D [(E)-4-(3-octenyl)phenol, 4] were synthesized by coupling the phenolic parts with the alkyne parts and then reducing the triple bond of the resulting alkynylphenols. These alkenylphenols (1-4) are the cytotoxic and antibacterial constituents of the leaves of a medicinal plant (Piper gibbilimbum) that is used as a traditional medicine in Papua New Guinea.

The protective effect of hochu-ekki-to (TJ-41), a Japanese herbal medicine, against HSV-1 infection in mitomycin C-treated mice.

BACKGROUND: Immmunosuppression and infectious disease in cancer patients receiving chemotherapy is a serious problem. Immunopotentiating drugs may show a therapeutic efficacy. MATERIALS AND METHODS: The protective effect of Hochu-ekki-to (TJ-41), a Japanese traditional herbal medicine, on mitomycin C (MMC)-induced immunosuppression has been investigated. Spleen weight, the number of forming colonies of granulocytes and macrophages (CFU-GM) in the bone-marrow cells, natural killer (NK) activity in splenocytes and susceptibility to lethal herpes simplex virus type-1 (HSV-1) infection were evaluated. RESULTS: Oral administration of TJ-41 (2000 mg/kg/day) restored MMC-induced decline of spleen weight. CFU-GM and NK activity (20.6% to 68.4%, 48.8% to 77.7%, 21.1% to 95.1%, respectively). Moreover, MMC treatment resulted in a lethal HSV-1 infection and TJ-41 showed a preventive effect. CONCLUSION: TJ-41 may be beneficial for the treatment of infectious diseases in immunocompromised patients receiving chemotherapeutic drugs.

[Chorioretinal blood flow changes following acupuncture between thumb and forefinger].

PURPOSE: To evaluate the effects of acupuncture stimuli on general circulation and chorioretinal blood flow changes, and to determine the duration of effect and the learning effect. OBJECTS AND METHODS: Twelve healthy young volunteers were divided into two groups. One had no experience of acupuncture (Non-Experience group); the other had experience of acupuncture (Experience group). Hegu (LI 4) between thumb and forefinger was acupunctured. Chorioretinal blood flow was measured via Heidelberg retina flowmeter before, during, and after acupuncture stimuli. RESULTS: In both groups, chorioretinal blood flow increased significantly during stimuli, with continuous bradycardia. The Experience group showed greater changes than the Non-Experience group. CONCLUSIONS: Chorioretinal blood flow was increased through relative parasympathetic reaction by stimulating an acupuncture point. Acupuncture is a promising adjunctive therapy for ischemic ocular diseases.

S-allylcysteine ameliorates doxorubicin toxicity in the heart and liver in mice.

Doxorubicin, a potent anticancer drug, is effective against a wide range of human neoplasms. However, the clinical uses of doxorubicin have been limited due to its serious cardiotoxic effects, which are likely the result of generation of free radicals and lipid peroxidation. S-Allylcysteine (SAC), an organosulfur compound purified from garlic, has been reported to have antioxidant and radical scavenging effects. Thus, we examined the effect of SAC on doxorubicin toxicity in mice. Severe doxorubicin toxicity was induced in mice by a single intraperitoneal injection (15 mg/kg body weight). SAC (30 mg/kg) was injected intraperitoneally daily for 5 days, starting two days prior to the administration of doxorubicin. Body weight was measured every alternate day. A measurement of serum creatine phosphokinase (CPK) and a histopathological analysis of the heart and liver was performed 6 days after the administration of doxorubicin. Death of any of the animals was recorded during the observation period. Doxorubicin injection induced a mortality rate of 58%, with SAC treatment reducing the doxorubicin-induced mortality rate to 30%. The severe body weight loss caused by doxorubicin (13%) was also significantly attenuated by SAC treatment (9%). Although an elevation of the level of serum CPK was observed following doxorubicin injection (5472 +/- 570 i.u./L), treatment with SAC significantly reduced the level of CPK (1923 +/- 635 i.u./L). Histological analysis demonstrated that heart and liver damage was significantly less severe in SAC treated mice than in mice receiving only doxorubicin. These results suggest that SAC research may ultimately lead to a resolution of the adverse effects of doxorubicin treatment in cancer chemotherapy.

[Autoimmune hepatitis with drug-induced pneumonia due to Sho-saiko-to].

A 71-year-old woman was being treated with Sho-saiko-to for chronic hepatitis. On the 14th day, she complained of dyspnea; chest X-ray films and CT scans revealed ground-glass shadows in both lung fields. Under a suspected diagnosis of drug-induced pneumonia, Sho-saiko-to was discontinued and the patient was started on prednisolone. After several days, her laboratory data and chest X-ray findings were markedly improved. Cell analysis of bronchoalveolar lavage fluid disclosed an increase in the lymphocyte fraction and a depressed CD 4/CD 8 count. Lymphocyte stimulation tests of Sho-saiko-to and its ingredients, Ohgon and Hange, were positive in the case of peripheral lymphocytes, but not bronchoalveolar lavage lymphocytes. These findings yielded a diagnosis of drug-induced pneumonia caused by Sho-saiko-to. A histologic examination of needle biopsy specimens from the liver revealed severe lymphocytic infiltration into the tissues of Glisson's capsule and liver parenchyma, and mild infiltration by plasma cells into tissues surrounding Glisson's capsule. To our knowledge, this is the first case of autoimmune hepatitis with Sho-saiko-to-induced pneumonia to be reported.

Anti-tumor promoting activity of polyphenols from Cowania mexicana and Coleogyne ramosissima.

Chemical investigation on polyphenol-rich fractions of Cowania mexicana and Coleogyne ramosissima (Rosaceae) which showed significant inhibitory effects on Epstein-Barr virus early antigen (EBV-EA) activation induced by 12-O-tetradecanoylphorbol-13-acetate (TPA), has led to the characterization of 10 compounds including C-glucosidic ellagitannin monomers and dimers from the former plant, and 17 polyphenols including flavonoid glycosides from the latter. The effects of individual components and their analogues with related structures on the TPA-induced EBV-EA activation were then evaluated. Among the compounds isolated from C. mexicana, two C-glucosidic ellagitannins, alienanin B and stenophyllanin A and a nitrile glucoside (lithospermoside), and among the constituents from C. ramosissima, two flavonoid glycosides, isorhamnetin 3-0-beta-D-glucoside and narcissin were revealed to possess strong inhibitory effects on EVB-EA activation, the potencies of which were either comparable to or stronger than that of a green tea polyphenol, (-)-epigallocatechin gallate. These polyphenols except for nitrile glucoside, which was not tested owing to an insufficient amount, were also found to exhibit anti-tumor promoting activity in two-stage mouse skin carcinogenesis using 7,12-dimethylbenz[a]anthracene (DMBA) and TPA.

Effect of Hochu-ekki-to (TJ-41), a Japanese herbal medicine, on the survival of mice infected with influenza virus.

The antiviral effect of Hochu-ekki-to (TJ-41), a Japanese herbal medicine, was investigated using mice infected with influenza virus. TJ-41 was found to increase the survival rate, prolong the mean survival days, suppress viral growth in bronchoalveolar labage fluid (BALF) and inhibit the lung index (lung consolidation) on day 4 after infection in mice infected with influenza, after the agent had been administered orally once daily from day 7 to 2 before infection and from day 0 to 4 after infection. Administration of TJ-41 decreased the BALF concentrations of IL-1alpha, IL-6 and GM-CSF, but not TNF-alpha or interferon-gamma (IFN-gamma), on day 4 after infection. In addition, TJ-41 elevated the level of IFN-alpha in BALF on day 2 after infection. Yet, TJ-41 did not show any inhibitory effect on the growth of influenza virus in vitro. These results suggest that TJ-41 exerts its inhibitory effect on influenza virus infection via enhancement of the host immune responses in this experimental murine system.

Synthesis of 2-(4-Hydroxyphenyl)naphthalene-1,8-dicarboxylic Anhydride, a Phytoalexin Isolated from Unripe Banana (Musa acuminata).

2-(4-Hydroxyphenyl)naphthalene-1,8-dicarboxylic anhydride, a component of the phytoalexin that has been isolated from the peel of unripe banana (Musa acuminata), was synthesized from 3-bromoacenaphthene.

Fine structure of rat liver, adrenal, testis and seminal vesicle in experimental emaciation.

Experimentally emaciated male rats were produced by a bilateral electrical destruction of a part of hypothalamus. In a typical case, when the animals were fixed by perfusion, dissected, and organs weighted, the body weight became 1/2 of the control in 10 weeks. The weight of the viscera (including the subserous fat) was more decreased in comparison with the controls than the weight of the body wall (including extremities and the subcutaneous fat). The weight of the liver became 1/3, the adrenal 1/4, the testis 1/6 and the seminal vesicle 1/19 of the control. Light and electron microscopic examinations showed atrophy and fatty degeneration in the liver, atrophy of the zona reticularis in the adrenal, failure of spermatogenesis, especially at its spermiogenetic stage, in the testis, and an apoptosis in glandular epithelial cells of the seminal vesicle. Two weeks after partial hypothalamus destruction, the weight of the body wall was more decreased in comparison with the controls than the weight of the viscera. Possible pathophysiological mechanisms are discussed. An experimental model of electron microscopical research of apoptosis are presented.

[Kampo medicines for the prevention of irinotecan-induced diarrhea in advanced non-small cell lung cancer].

A combination of irinotecan hydrochloride (CPT-11; 160 mg/m2, intravenous infusion, day 1) and cisplatin (5-day continuous intravenous infusion; 20 mg/m2/day) was administrated to advanced non-small cell lung cancer patients. They were given Hangeshashin-to (TJ-14), a Kampo medicine, to prevent the occurrence of irinotecan-induced diarrhea. The authors studied the Kampo medicine's clinical usefulness in a randomised comparative trial. Subjects in the study comprised 41 non-resectable and untreated non-small cell lung cancer patients. A daily dosage of 7.5 g Hange shashin-to was divided into three portions, each of which was given to the subjects orally before each meal. The subjects began taking the medicine three or more days before the start of chemotherapy, and continued taking it more than 21 days after starting chemotherapy. A total of 18 patients received TJ-14, and 23 did not. Compared with the latter, those given the Kampo medicine reported a significant (p = 0.044) improvement in the grade of diarrhea, and had a lower incidence of diarrhea grade 3 and above (p = 0.018). However, no differences were seen among the two groups in terms of the frequency of diarrhea and the duration of the diarrhea. As side effects, two patients developed grade 1 constipation. These findings showed that TJ-14 was effective in preventing and alleviating the incidence of diarrhea induced by CPT-11.

Immunosuppressants decrease neutrophil chemoattractant and attenuate ischemia/reperfusion injury of the liver in rats.

BACKGROUND: Neutrophils may play an important role in the development of liver ischemia/reperfusion injury. We investigated the effects of the immunosuppressants azathioprine (AZA), cyclosporine A (CsA), tacrolimus (FK506), and rapamycin (RPM) on the expression of cytokine-induced neutrophil chemoattractant (CINC) after ischemia/reperfusion of the liver. METHODS: Liver ischemia was induced in male Wistar rats by occluding the portal vein with a microvascular clip for 30 minutes. Rats received two intramuscular injections of AZA (4 mg/kg), CsA (5 mg/kg), FK506 (0.5 mg/kg), or RPM (0.5 mg/kg) 3 and 24 hours before ischemia/reperfusion of the liver. RESULTS: Serum CINC concentrations in untreated animals increased, peaked 6 hours after reperfusion, and thereafter decreased gradually. Pretreatment with AZA, CsA, FK506, and RPM, however, inhibited the increase in serum CINC concentrations after reperfusion. CINC mRNA in liver tissue increased and peaked 3 hours after reperfusion, but was significantly lower in animals treated with AZA, CsA, FK506, and RPM. In vitro CINC production by Kupffer cells harvested from animals treated with AZA, CsA, FK506, or RPM 3 hours after reperfusion was also significantly lower than that observed in untreated animals. Both myeloperoxidase activity and the number of neutrophils accumulating in the liver 24 hours after reperfusion in animals treated with AZA, CsA, FK506, and RPM were significantly lower than in untreated animals. This correlated with lower serum aspartate transaminase, alanine transaminase, and lactate dehydrogenase levels in animals treated with AZA, CsA, FK506, and RPM 24 hours after reperfusion. CONCLUSION: The immunosuppressants AZA, CsA, FK506, and RPM reduce neutrophil accumulation and attenuate ischemia/reperfusion injury of the liver.

Kidney-specific expression of a novel mouse organic cation transporter-like protein.

Using the signal sequence trap method, we have cloned a novel 12-membrane-spanning transporter-like protein, termed renal-specific transporter (RST), from the mouse kidney. RST is a 553-amino-acid protein highly homologous to recently cloned organic cation transporters, e.g. it is 30% identical to rat organic cation transporter I at the amino acid level. Northern blot analysis has revealed that the RST gene is expressed abundantly and specifically in the kidney. In situ hybridization analysis has shown that RST gene expression is restricted to the renal proximal tubule, where various organic cations such as endogenous catecholamines and choline or clinically used cationic drugs are known to be actively excreted.

Enhancement of passive immunity with maternal vaccine against newborn calf diarrhea.

The effects of a maternal vaccine against newborn calf diarrhea associated with group A bovine rotavirus (BRV), bovine coronavirus (BCV), bovine parvovirus and K99 Escherichia coli (E. coli) were examined on a beef cow-calf herd. After vaccination, serum or colostrum antibody titers to BRV, BCV and E. coli K99 in the vaccinated cows were significantly higher than those in unvaccinated control cows. Serum antibody titers to BRV, BCV and E. coli K99 in calves from the vaccinated cows were also significantly higher than those in calves from the control cows for 3-4 weeks after birth. These results suggested that the immunization of cows with the maternal vaccine enhanced the passive immunity levels in calves against BRV, BCV and K99 E. coli.

[A case of liver metastases from leiomyosarcoma in the chest wall which was made resectable by chemoembolization].

We here report a recently experienced case in which TAE and intra-arterial infusion chemotherapy for treatment of liver metastases of leiomyosarcoma in the chest wall caused a shrinking of the metastasized focus, thus facilitating liver resection. Patient; a 38-year-old man Present History and Courses; Resection of leiomyosarcoma in his chest wall was done in May, 1994. However, a local recurrence was noted in September, 1995, and the tumor was removed. Then, he received systemic chemotherapy with CDDP (100 mg) and ADM (45 mg). Abdominal CT and ultrasonic examinations made in February, 1996 revealed liver metastases at S2,5,8. Angiography detected densely stained images of tumors at a number of sites along with S2,5,8. Since these were thought unresectable, TAE therapy with EPIR (30 mg) and lipiodol (4 ml) was attempted 3 times. Then, a reservoir for intra-hepatic arterial infusion was implanted in April, 1996 and EPIR at a dose of 30 mg (150 mg in total) was given through arterial infusion, resulting in tumor disappearance at S5,8 but further growth of the tumor metastasizes at S2. Therefore, a resection of the left lateral segment of liver was done August 23. Though he was discharged in October, metastasis was found in the thoracic spine in December. Thus, he underwent resection of the vertebral arch including the tumor.

STAT5 activation correlates with erythropoietin receptor-mediated erythroid differentiation of an erythroleukemia cell line.

Interaction between erythropoietin (EPO) and its membrane receptor induces the proliferation and differentiation of erythroid progenitors. EPO has been shown to activate the JAK2-STAT5 pathway in various hematopoietic cell lines, although the physiological role of this pathway is unclear. We have previously shown that epidermal growth factor activates a chimeric receptor bearing the extracellular domain of the epidermal growth factor receptor linked to the cytoplasmic domain of the EPO receptor, resulting in proliferation of interleukin-3-dependent hematopoietic cells and erythroid differentiation (globin synthesis) of EPO-responsive erythroleukemia cells. In the present study, we introduced various deletion and tyrosine to phenylalanine substitution in the cytoplasmic domain of the chimeric receptor and expressed these mutant chimeras in an EPO-responsive erythroleukemia cell line, ELM-I-1. Mutant chimeric receptors retaining either Tyr343 or Tyr401 could activate STAT5, judged by tyrosine-phosphorylation of STAT5 and induction of CIS, a target gene of STAT5. These mutants were able to induce erythroid differentiation. However, a chimeric receptor containing both Y343F and Y401F mutations could not activate STAT5 nor induce erythroid differentiation. Thus, Tyr343 or Tyr401 of the EPO receptor are independently necessary for erythroid differentiation as well as STAT5 activation. Moreover, exogenous expression of dominant-negative STAT5 suppressed EPO-dependent erythroid differentiation. These findings suggest that STAT5 plays an important role in erythroid differentiation through the EPO receptor cytoplasmic domain.

What influences social skills in patients with schizophrenia? Preliminary study using the role play test, WAIS-R and event-related potential.

Persons with schizophrenia exhibit disabilities which profoundly affect their social and independent living skills, and social skills training is expected to be an effective treatment for reducing the level of severity of disabilities. Many factors may influence usage and learning of social skills; little is definitively known regarding which disabilities related to schizophrenia compromise social skills. The present report deals with factors affecting social skills. Twenty persons with schizophrenia (DSM-III-R) were tested using a Japanese version of the role play test, the reliability and validity of which were verified. Subjects were also tested using BPRS, auditory event-related potential (ERP) and WAIS-R. Nonverbal skills showed significant positive correlation with the amplitude of the N1 ERP component and age of onset, and 59% of the variance of nonverbal skills was accounted for by these factors using multiple regression analysis. Nonverbal skills are at least partially based on either automatic discriminating processes or selective attention, reflected in N1A. Information receiving and processing skills showed significant positive correlation with Performance IQ and Global Assessment of Functioning, and 61% of the variance of receiving and processing skills was accounted for by BPRS score, PIQ score and age. These skills are not directly related to elementary cognitive function as assessed by analyzing, for example, the ERP P3 component, but are based on more complex neuropsychological function.