Applying recommended definition of aggressive prostate cancer: a validation study using high-quality data from the Cancer Registry of Norway.

BACKGROUND: The Prostate Cancer Cohort Consortium (PC3) Working Group proposed a definition for aggressive prostate cancer (PC) for aetiologic epidemiologic research. We aimed to validate this definition as well as a second approach utilising only information on stage at diagnosis. METHODS: First primary PCs diagnosed 2004 - 2009 in the population-based Janus Serum Bank (JSB) cohort were identified by linkage to the population-based Cancer Registry of Norway (CRN) (n = 3568). The CRN and Norwegian Prostate Cancer Registry provided clinicopathological data for these cases. Approach 1 classified PC as aggressive if it was clinically T4, or N1, or M1, or had a Gleason score ≥8 at diagnosis (as proposed). Approach 2 classified PC as aggressive if CRN stage at diagnosis was 'regional spread' or 'distant metastases'. Both approaches were validated by calculating the sensitivity and positive predictive value (PPV) against PC-death within 10 years of diagnosis. RESULTS: Overall, 555 died from PC within 10 years. Approach 1 classified 24.7% of cases as aggressive and 13.6% were unclassified due to missing information. Approach 2 classified 19.6% as aggressive and 29% were unclassified. Sensitivity was highest for Approach 1 (0.76, 95% CI: 0.72 - 0.80 vs 0.69, 95% CI: 0.64 - 0.73), while PPVs were similar for both approaches (0.43, 95% CI: 0.40 - 0.46 and 0.40, 95% CI: 0.36 - 0.44). We observed similarly high sensitivity and higher PPVs than those reported by the PC3 Working Group. CONCLUSIONS: The proposed definition of aggressive PC was applicable and valid in the JSB cohort. Stage at diagnosis can be useful if data on cTNM or Gleason score is unavailable.

All-optical flip-flop operation based on asymmetric active-multimode interferometer bi-stable laser diodes.

We demonstrate fast and low energy all optical flip-flop devices based on asymmetric active-multimode interferometer using high-mesa waveguide structure. The implemented devices showed high speed all-optical flip-flop operation with 25 ps long pulses. The rising and falling times of the output signal were 121 ps and 25 ps, respectively. The required set and reset pulse energies were only 7.1 fJ and 3.4 fJ, respectively.

Sporadic isolations of a multi-drug resistant Pseudomonas aeruginosa clone during a 14-month epidemic in a general hospital in Hiroshima.

BACKGROUND: During 2005-2007, we experienced sporadic isolations of multidrug-resistant (MDRP) Pseudomonas aeruginosa from wards in a general hospital in Hiroshima. The objective of this study was to analyze epidemiology relationships and the mode of spread of the strains. METHODS: Clonality was assessed using pulsed-field gel electrophoresis (PFGE) and serotyping. MICs were determined using the microdilution broth method. Investigations of the affected patients' movements and environmental sampling from the affected wards were conducted. RESULTS: An abrupt increase in MDRP isolations began at the end of 2005 and ended in February 2007. A total of 25 MDRP strains were sporadically isolated from nine wards. Fourteen strains were genotypically and serologically identical. Analysis of the patients' movements identified that six of the 14 MDRP-positive patients became positive for MDRP when they were in the intensive care unit (ICU), and two became positive after the patients moved from the ICU to another nursing unit. Four MDRP strains were isolated from patients who did not stay in the ICU and were in ward E6, which had the second highest number of isolations. In July 2006, environmental sampling of the hospital identified a toilet brush in ward E6 that was contaminated with MDRP that was genotypically and serologically identical to the clinical isolates. CONCLUSIONS: Our study suggests that the sporadic increase in MDRP isolates during 2005-2007 in the general hospital in Hiroshima was due to an epidemic of an MDRP clone. Continuity and spread of infection was probably due to cross infection and contamination in the hospital with the MDRP strain.

Topical application of Aggregatibacter actinomycetemcomitans cytolethal distending toxin induces cell cycle arrest in the rat gingival epithelium in vivo.

BACKGROUND: Aggregatibacter actinomycetemcomitans is one of the etiological pathogens implicated in the onset of periodontal disease. This pathogen produces cytolethal distending toxin (CDT) that acts as a genotoxin to induce cell cycle arrest and cellular distension in cultured cell lines. Therefore, CDT is a possible virulence factor; however, the in vivo activity of CDT on periodontal tissue has not been explored. Here, CDT was topically applied into the rat molar gingival sulcus; and the periodontal tissue was histologically and immunohistochemically examined. MATERIALS AND METHODS: Recombinant purified A. actinomycetemcomitans CDT was applied to gingival sulcus of male Wistar rats and tissue samples were immunohistochemmically examined. RESULTS: One day after application, infiltration of neutrophils and dilation of blood vessels in the gingival connective tissue were found. At day three, desquamation and detachment of cells in the junctional epithelium was observed. This abrasion of junctional epithelium was not observed in rats treated with mutated CDT, in which a His274Ala mutation is present in the CdtB subunit. This indicates the tissue abrasion may be caused by the genotoxicity of CdtB. Expression of the proliferating cell nuclear antigen (PCNA), a marker for proliferating cells, was significantly suppressed using CDT treatment in the junctional epithelium and gingival epithelium. CONCLUSION: Using the rat model, these data suggest CDT intoxication induces cell cycle arrest and damage in periodontal epithelial cells in vivo.

Clonal distribution of enterotoxigenic Staphylococcus aureus on handles of handheld shopping baskets in supermarkets.

AIMS: Shopping carts and handheld shopping baskets in supermarkets are subject to accidental bacterial contamination through contacts with a variety of food. We investigated the prevalence of Staphylococcus aureus on the handles of handheld shopping baskets in four supermarkets distantly located in Osaka district, Japan. METHODS AND RESULTS: Fifty two strains of Staph. aureus were isolated from 760 basket handles. Among these, six strains were positive for staphylococcal enterotoxin B (SEB) production, representing 12% of total. This SEB producer ratio is considerably higher than among Staph. aureus isolated from nasal swabs of the supermarket workers (2%) and from independently collected clinical specimens (4%). These SEB-producing Staph. aureus strains from the basket handles are clonal and belong to ST12. Coagulase typing showed that they are in group VII, which is the most common cause of food poisoning in Japan. Biofilm assays indicated that SEB gene (seb)-positive strains including this clone produced a significantly higher amount of biofilm than seb-negative strains. CONCLUSIONS: The frequent isolation of seb-positive Staph. aureus on shopping basket handles raises the possibility that they could be a hidden reservoir for Staph. aureus with a potential to cause food poisoning and draws attention to the importance of shopping basket sanitation.

Fas gene mutation in the progression of adult T cell leukemia.

Fas antigen (Apo-1/CD95) is an apoptosis-signaling cell surface receptor belonging to the tumor necrosis factor receptor superfamily. Adult T cell leukemia (ATL) cells express Fas antigen and show apoptosis after treatment with an anti-Fas monoclonal antibody. We established the ATL cell line KOB, which showed resistance to Fas-mediated apoptosis, and found that KOB expressed two forms of Fas mRNA, the normal form and a truncated form. The truncated transcript lacked 20 base pairs at exon 9, resulting in a frame shift and the generation of a premature stop codon at amino acid 239. The same mutation was detected in primary ascitic cells and peripheral blood cells. The mutation was not detected in lymph node cells, however, although all of the primary ATL cells were of the same clonal origin. A retroviral-mediated gene transfer of the truncated Fas to Jurkat cells rendered the cells resistant to Fas-mediated apoptosis, suggesting a dominant negative interference mechanism. These results indicate that an ATL subclone acquires a Fas mutation in the lymph nodes, enabling the subclone to escape from apoptosis mediated by the Fas/Fas ligand system and proliferate in the body. Mutation of the Fas gene may be one of the mechanisms underlying the progression of ATL.

Detection of a single bacterial cell using a 16S ribosomal RNA-specific oligonucleotide probe designed to investigate periodontal pathogens.

INTRODUCTION: The current detection methods for periodontopathogens mainly use polymerase chain reactions. However, there are few methods available for visualizing the bacteria that impact on patients with periodontal disease for use in health education. The purpose of this study was to develop a specific detection method to visualize periodontopathogenic bacteria. METHODS: Fluorescently-labeled oligonucleotide probes directed to specific 16S ribosomal RNA (rRNA) sequences of Porphyromonas gingivalis and Aggregatibacter actinomycetemcomitans were synthesized. Cultured individual bacterial species were fixed with 4% paraformaldehyde and smeared on glass slides. Fluorescein isothiocyanate-labeled oligonucleotide probes were hybridized under stringent conditions with smeared whole cells, and then probe specificity was investigated by epifluorescence microscopy. RESULTS: Comparatively long (50-mer) oligonucleotide probes for P. gingivalis and A. actinomycetemcomitans were designed. These probes clearly hybridized with 16S rRNA of the target species in situ and single bacterial cells were detectable visually. The probes exhibited no cross-hybridization against the additional organisms that were closely related to the target species. CONCLUSIONS: The fluorescence in situ hybridization technique is a specific and reliable method by which to visually identify the target organisms. The oligonucleotide probes designed in this study will be useful for detecting P. gingivalis and A. actinomycetemcomitans populations.

Fas-resistance in ATL cell lines not associated with HTLV-I or FAP-1 production.

A preventive role for human T-cell leukemia virus type-I (HTLV-I) and Fas-associated phosphatase-1 (FAP-1) in Fas-mediated apoptosis has been reported in HTLV-I-infected cells. In the present study, we examined whether these molecules increased during the acquisition of Fas-resistance in adult T-cell leukemia (ATL) cell lines. SO4, ST1 and KK1 are Fas-sensitive ATL cell lines, and produce small amounts of HTLV-I in vitro. Although their subclones RSO4 and RST1 are completely Fas-resistant, they produced an equivalent amount of HTLV-I to SO4 and ST1. Moreover, FAP-1 mRNA was not detected in these cell lines irrespective of Fas sensitivity. Thus, Fas resistance in ATL cells was not directly associated with the increased production of HTLV-I or FAP-1.

Qualitative and quantitative characterization of Fas (APO-1/CD95) on leukemic cells derived from patients with B-cell neoplasms.

Expression density and function of Fas (APO-1/CD95) on malignant B-cells, an antigen thought responsible for abnormal tumor biology, remains to be fully understood. Fifty-five cases with B-cell neoplasms of acute lymphoblastic leukemia (ALL), chronic lymphocytic leukemia (CLL), hairy cell leukemia (HCL), B-cell malignant lymphoma (ML), and myeloma (MM) were studied for qualitative and quantitative expression and function of Fas using flow cytometry and annexin-V staining methods. Fas expression was flow cytometrically unimodal with heterogeneous density and showed quantitatively characteristic features among different diseases; weak in ALL, faint in CLL, moderate in HCL, and strong in ML, respectively. Not only full-length but also alternatively spliced truncated mRNAs were detected even in leukemic B-cells with qualitatively faint or negative Fas, and then band density of the former transcripts by RT-PCR was correlated to the Fas protein expression level. Short-term culture of freshly isolated cells gave rise to increases of Fas density and susceptibility for apoptosis, suggesting that the mRNA and inducible Fas are functional at least in vitro. These results show that Fas is a biological marker for characterizing B-cell neoplasms reflecting various stages of B-cell ontogeny and may have clinical utility as a therapeutic strategy.

Qualitative and quantitative characterization of Fas (CD95) expression and its role in primary human acute leukemia cells.

Fas antigen, a cell surface molecule, directly mediates apoptosis, and is expressed on a limited number of human tissues. Blood or bone marrow samples from patients with acute myelogenous leukemia (AML), acute lymphoblastic leukemia (ALL) and mixed leukemia were examined qualitatively and quantitatively for the expression of Fas as well as its function using flow cytometry and the annexin V staining method. Fas expression was flow cytometrically unimodal with heterogeneous density, and showed quantitatively characteristic features in different diseases: undetectable in mixed leukemia, faint to weak in ALL, low in M0 and M1, and variable (low to strong) in M2, M3, M4, and M5. Both the full-length and the alternatively spliced truncated mRNAs were detected constitutively even in acute leukemia cells with qualitatively negative and quantitatively faint Fas, and the band density of the former transcripts detected by RT-PCR was correlated with the level of expression of the Fas protein. Short-term culturing of freshly isolated leukemia cells gave rise to an increase of Fas density. In acute leukemia cells, the apoptosis induced by anti-Fas MoAb was compared with that induced by etoposide (a topoisomerase II inhibitor). We found that fresh ALL and AML cells were resistant to the anti-Fas IgM antibody, while etoposide could trigger apoptosis in all types of leukemia tested. The combined effects of the anti-Fas MoAb and etoposide were not always synergistic. These results suggest that Fas is a biological marker for characterizing ALL and AML cells, and provide insight into creating a new therapeutic modality using cytotoxic drugs and cytokines together with modulation of Fas.

CD5-expressing B-cell lymphomas/leukemias: relatively high frequency of CD5+ B-cell lymphomas with an overall poor prognosis in Nagasaki Japan.

To characterize CD5+ B-cell neoplasms in Japan, where chronic lymphocytic leukemia (CLL) is rare and of different subtypes in comparison with Western countries, we collected 58 cases of CD5+ B-cell lymphomas/leukemias and analyzed their clinicopathologic features. According to the French-American-British (FAB) and standard histologic classification, the cases corresponded to small lymphocytic lymphoma (SLL, group I; n = 22, consisting of CLL, n = 10, CLL/PL, n = 3, and CLLmixed, n = 7); intermediate differentiated lymphoma/mantle cell lymphoma (IDL/MCL, group II, n = 18); and others with CD5-positive lymphomas (group III, n = 18). The CD5+ B-cell lymphomas showed morphologic and prognostic variability among the three groups. The clinical and immunophenotypic features were remarkably consistent in leukemic disease being seen in 73% of all cases, splenomegaly in 63%, and intense CD19, CD20, surface membrane immunogobulin M (SmIgM) or SmIgM and SmIgD, light-chain expression, and no CD10 expression. The median survival time of groups I, II, and III was 7.8, 3.3, and 0.8 years, respectively. These findings suggest that CD5 antigens may serve as valid markers for the prognosis and clinical features of B-cell lymphomas and that CD5+ B-cell lymphomas with an overall poor prognosis occurs at a relatively high frequency in Japan. This also suggests that a combination of immunophenotypic and morphologic features is of value for characterizing CD5+ B-cell neoplasms.

Clonal analysis of B-cell leukemias and lymphomas using the polymerase chain reaction for the third complementarity determining region of the IgH gene: a study of 75 cases from Nagasaki Japan.

Using semi-nested polymerase chain reaction (PCR), we examined 75 Japanese cases of hematologic malignancies with B-cell antigens including 25 common acute lymphoblastic leukemia (ALL), 13 chronic lymphocytic leukemia (CLL), 28 B-cell malignant lymphoma (B-ML), 2 hairy cell leukemia (HCL), 7 acute myelogenous leukemia with B-cell antigens (AML-B), and 23 controls. When amplified products were analysed by a standard polyacrylamide gel electrophoresis, the sensitivity for detection of clonal IgH rearrangements in each group of ALL, CLL, B-ML, HCL, and AML-B was 88%, 92.3%, 71.4%, 100%, and 57.1%, respectively, with an overall sensitivity of 80.0%. There were no false positive results in any of the control samples. Single strand conformation polymorphism (SSCP) analysis of the amplified products gave rise to a much greater sensitivity, up to 84% overall. The false negative samples were mainly encountered in B-ML with SmIgG and non-Ig, suggesting miss-annealing between the primers used and the template DNA because of somatic hypermutation of IgH genes in such clones. This indicates that PCR analysis is very useful in detecting the clonal IgH rearrangements in B-cell malignancies, especially in ALL and CLL, but not in B-ML corresponding to neoplasms originating from pre-germinal center naive B-cells.

Occurrence of tetrodotoxin in the skin of a rhacophoridid frog Polypedates sp. from Bangladesh.

Twenty-three specimens of a tree-frog Polypedates sp. were collected from two locations (Mymensingh and Barisal) of Bangladesh in 1999, and assayed for their toxicity scores and toxin principle. Among the tissues, only the skin of the Mymensingh specimens was found to be toxic in mouse test, with the toxicity scores of 31-923MU/g. The toxin isolated from the skin was analyzed by high-performance liquid chromatography, electrospray ionization-time of flight mass spectrometry and proton nuclear magnetic resonance, and characterized as tetrodotoxin, a toxin principle.

Effects of fluoride intake on the mineral content, acid solubility and resorption caused by experimental periodontitis of rat alveolar bone.

Adult rats were given either distilled water or drinking water containing 100 parts/10(6) of fluoride. The alveolar bone of rats given fluoride for 90 days showed an increased mineral content and decreased acid solubility compared to the bone of rats given distilled water. Experimental periodontitis was initiated in both groups after 110 days of treatment to cause alveolar bone resorption. Fourteen days later, the rats were killed and it was found that the alveolar bone resorption caused by experimental periodontitis was significantly smaller in the rats given fluoride in their drinking water than in those given distilled water. The findings suggest that fluoride intake might have a protective effect on rapidly progressing alveolar bone resorption.

Antibacterial effect of silver-zeolite on oral bacteria under anaerobic conditions.

OBJECTIVES: The purpose of this study was to evaluate the antibacterial effect of silver-zeolite (SZ) against oral bacteria under anaerobic conditions. METHODS: The antibacterial activity of SZ was evaluated by determining the minimum inhibitory concentrations (MICs) using two-fold serial dilutions of SZ in Brain Heart Infusion broth. Release of Ag+ into the broth was measured by an atomic absorption technique. RESULTS: SZ inhibited the growth of the bacteria tested under anaerobic conditions. The MIC of SZ ranged between 256 and 2048 micrograms/ml, which corresponded to a range of 4.8-38.4 micrograms/ml of Ag+. All strains grew in broth containing 16,384 micrograms/ml of type-A zeolite. SIGNIFICANCE: These results suggested that SZ may be a useful vehicle to provide antibacterial activity to dental materials used even under anaerobic conditions such as deep in the periodontal pocket.

Pilot study on the effect of a mouthrinse containing silver zeolite on plaque formation.

A double-blind cross-over study was performed to evaluate the inhibitory activity of silver zeolite (SZ) mouthrinse on plaque formation. Eleven dental students participated in this study. SZ mouthrinse was prepared by suspending SZ powder into phosphate-buffered saline (PBS) at a concentration of 3% (w/w). Type-A zeolite was used as a placebo. Before the experiment, the subjects were rendered plaque-free by professional prophylaxis. They then suspended any oral hygiene for five days, during which time they rinsed with either SZ or type-A zeolite mouthrinse twice a day. SZ significantly reduced plaque formation compared to the placebo (p < 0.05), suggesting that silver ions released from the SZ inhibited plaque formation.

[Analysis of bone loss with aging and menopause--using digital image processing].

To study bone loss relationships to aging and menopause, cross-sectional bone mass measurements by digital image processing (DIP method), and menopause information collected by questionnaire, were analyzed on 291 women who live in Tsukude village. The results are as follows. 1) The mean DIP values (sigma GS/D, MCI) by age-stratified groups decrease with age after menopause. The rate of bone loss in sigma GS/D is almost constant, but in MCI it increases with aging. 2) In 30-year old and 40-year old age groups, the frequency distribution of DIP values is symmetrical and bell-shaped. But after the fifties the distribution is asymmetrical, with the mode of distribution deviated toward low bone mass. The change of mode with aging is larger than that of mean. This fact suggests that change of mean bone mass substantially underestimates actual bone loss from aging. 3) The change of the mean DIP values stratified by years elapsed since menopause is not especially large at start of menopause but becomes almost constant after menopause. DIP values reflect the bone loss from the aging rather than from menopause, and are beneficial to the study of bone loss in elderly women.

[Health problems treated by primary care physician].

For the purpose of clarifying functions expected of primary care physicians (PC physicians) in Japan, a study of the types and frequencies of health problems seen in primary care clinics located in three areas, together with consultation/referral rates of the patients to other institutes. The study was conducted using ICHPPC-2 (Japan version) which had been compiled by WONCA as a classification of diseases. In order to obtain much more generalized characteristics of the primary care, clinics located in the city, suburban district and remote places in the mountains were studied. The results were as follows: 1) The health problems treated by the clinics in each of the three areas were respectively: 162 types/7,207 items/4 months: 303 types/17,519 items/2 years: and 280 types/61,916 items/2 years. 2) The consultation/referral rates were under 2%. 3) PC physicians treated over 98% of the health problems encountered. This was found by the investigation, which had been intended to disclose a range of so-called COMMON DISEASES treated by PC physicians themselves, based on a relation between the referral rates and the types of health problems. The above findings suggested that the COMMON DISEASES should include at least 95% of the health problems which had been treated by the PC physicians. This corresponded to approximately 100 types of diseases.

[Support system for diagnosing hematologic malignancies].

We established a Southern blot hybridization using a DIG-labeled probe to detect monoclonal integration of HTLV-1 proviral genome. DIG was labeled by the PCR method and this probe was as sensitive as the 32P-labeled probe and able to detect only 1.6% of ATL cells. The clinical diagnoses of 44 patients with monoclonal band(s) were all ATL. In contrast, the clinical diagnoses of 39 patients without monoclonal band(s) were diseases other than ATL. We also performed a long PCR of HTLV-1 to characterize the integrated provirus. The method allowed us to find a defective provirus, which was frequently observed in aggressive forms of ATL; 14 of the 18 patients with acute type(78%), 6 of the 9 patients with lymphoma type(67%), and 2 of the 12 patients with chronic type(17%) had the defective provirus. We established a simultaneous PCR for each region of HTLV-1 for further examination of the defective provirus. To detect the monoclonality of IgH gene rearrangement of B-cells, we performed PCR according to the method described. None of 13 patients with T-lymphoproliferative disorders showed a monoclonal band. In contrast, 12 of 13 patients with CLL(92%), 22 of 25 patients with common ALL(88%), 18 of 24 patients with B-lymphoma(75%), and 3 of 3 patients with hairy cell leukemia(100%) showed a monoclonal band. We are now expanding this kind support system for the clinical diagnosis at a molecular biology level in the central laboratory.

[Monoclonal analysis in B-cell neoplasms by the semi-nested polymerase chain reaction using consensus primers].

Monoclonality on B-cells is well known to be determined on the basis of presence of a rearranged-IgH gene, which is detected by Southern blot hybridization (SBH) remaining to be elucidated in respects of not only time-consumed, labour and cost benefit and also the use of much DNA samples. Alternative to this SBH, we examined the clinical usefulness of monoclonal analysis by the polymerase chain reaction technique which amplifies rearranged-CDR III region of IgH gene (IgH-PCR). The detective sensitivity of the IgH-PCR was different dependently upon each analysis for amplified products, namely 10(-2) per mononuclear cells in agarose gel analysis and 10(-3) in polyacrylamide gel and single strand conformation polymorphism analysis (PAGE and SSCP). Then, using the IgH-PCR and PAGE/SSCP analysis, 75 Japanese patients with B-neoplasm and 23 with T-cell neoplasms were examined for clonal IgH rearrangements. The diagnostic sensitivity in each group of B-ALL, B-CLL, B-lymphoma, HCL, AML with B-cell antigens, and non-T cell neoplasms was 88%, 92.3%, 71.4%, 100%, 57.1%, and 0%, respectively, with an overall sensitivity and specificity of 88% and 100%. This indicates that PCR analysis is very useful in detecting the clonal rearrangement of IgH genes on B-cell neoplasms, especially on ALL and CLL corresponding to neoplasms counterparting to naive B-cells.