Newly Developed Ultrasonic Probe With Ropeway System for Transpapillary Intraductal Ultrasonography of the Bilio–Pancreatic Ductal System

Background: Intraductal ultrasonography of the bile/pancreatic duct using a thin‐caliber ultrasonic probe (IDUS) provides excellent images of these ducts and the surrounding structures. Insertion of the device through the papilla of Vater is essential to carry out this examination. We developed a new probe with a ropeway system (XUM5RG‐29R; Olympus, Tokyo) for transpapillary IDUS. Its usefulness such as ease of application and safety were prospectively evaluated. Patients and methods: During the period of October 1997 to April 1998, transpapillary IDUS using the probe was performed in 194 patients at seven medical institutions. The success rates of insertion of the probe into the bile/pancreatic duct, observation of the area of interest, and the incidence of complications were evaluated. Results: Passage of the probe through the papilla was successful without difficulty in all the patients. Successful introduction of the probe into the pancreatic duct, bile duct and both of the ducts was achieved in 98.4, 100 and 85% of the patients, respectively. Once the probe was introduced into the aimed duct, it was possible to obtain IDUS images of the area of interest in all but five patients. Mild acute pancreatitis developed in eight patients (4.1%), all of whom recovered with conservative therapy only. Conclusions: It is possible to introduce the new ultrasonic probe into the desired duct once a guide wire has been inserted. This type of ultrasonic probe is quite useful when performing transpapillary IDUS of the bile and/or pancreatic duct.     

Effect of extensive lymph node dissection on the survival of early gastric cancer.

BACKGROUND/AIMS: A retrospective analysis of 628 cases of early gastric cancer was performed to evaluate prognostic significance of extensive lymph node dissection. METHODOLOGY: The patients were assigned to either D0/D1 (n=177) group or D2/D3 group (n=451) according to the extent of lymph node dissection and the survival of the two groups was compared. RESULTS: The survival rate of D2/D3 group was significantly higher than D0/D1 group in the case of both including and excluding unrelated cause of death (p<0.0001 and p<0.005, respectively). CONCLUSIONS: Though early gastric cancer is excellent prognostic disease, very few numbers of patients with recurrence really remain. Our data show extensive lymph node dissection was effective to prolong the survival of patients with early gastric cancer.     

Prognostic significance of programmed cell death‐1‐positive cells in follicular lymphoma patients may alter in the rituximab era

Programmed cell death‐1 (PD‐1) is involved in one of the inhibitory pathways of the B7‐cluster of differentiation (CD) 28 family; this pathway is known to be involved in the attenuation of T‐cell responses and promotion of T‐cell tolerance. PD‐1 is known to negatively regulate T‐cell receptor‐mediated proliferation and cytokine production, lead to alternation in the tumor microenvironment. Although several studies have shown that high levels of PD‐1‐positive cells in follicular lymphoma (FL) patients influence their prognosis, those studies included patients treated without rituximab, and the prognostic impact of PD‐1 positivity in the rituximab era (R‐era) has not yet been elucidated. We retrospectively studied 82 patients with FL uniformly treated with standard R‐CHOP therapy at six institutions between 2001 and 2009 (median follow‐up for survivors: 55 months). We also collected and examined biopsy specimens for diagnosis with respect to PD‐1 positivity. The PD‐1 positivity was significantly higher in male patients and patients with high beta‐2 microglobulin (B2M ≥ 3.0) (P = 0.03 and 0.003, respectively). Three‐year progression free survival (PFS) and overall survival (OS) were 60% and 86%, respectively. By univariate analysis, elevated LDH (P = 0.07) worsened PFS. Male gender (P = 0.03), high FLIPI score (P = 0.05), and high B2M levels (P = 0.08) worsened OS. Multivariate analysis detected no significant prognostic factors, including PD‐1 positivity. However, in male subgroup, high levels of PD‐1‐positive cells were found to be a prognostic factor for PFS. Addition of rituximab might have altered the prognostic impact of PD‐1‐positive cells.     

Effect of communication skills training on nurses' detection of patients' distress and related factors after cancer diagnosis: a randomized study

Background: A randomized study was performed to investigate whether a communication skill (CS) training program can improve nurse's ability to detect the distress of patients who have just been informed of cancer diagnosis. Methods: Nurses were randomly assigned to the experimental or control group, and those in the former group had undergone CS training program. Nurses in both groups were then requested to support patients informed of their cancer diagnosis. Intervention consisted of one‐on‐one nurse interviews 3 times (on the day, 1 week, and 1 month after diagnosis). Patient's self‐reported distress according to the Hospital Anxiety and Depression Scale and nurse's ratings of patient distress by Visual Analog Scale were assessed 3 times (1 week, 1 month, and 3 months after diagnosis). These two scales were compared between the nurses of the two groups to assess the impact of CS training. Results: The nurses in the experimental and control groups supported 42 and 47 patients, respectively. The analysis using mixed‐effects modeling revealed no significant differences in the nurse's ability to detect patient's distress between the two groups. However, when the nurse's ratings of patient's distress and patient's self‐reported distress were compared, these two scores were significantly correlated only with the nurses in the experimental group, suggesting that the nurse's ability to become aware of patient's distress had been improved in that group. Conclusions: CS training for health professionals is useful in oncology practice to improve nurse's ability to recognize the distress of patients diagnosed with cancer. Copyright © 2009 John Wiley & Sons, Ltd.     

Selective lack of intercellular communication between transformed and nontransformed cells as a common property of chemical and oncogene transformation of BALB/c 3T3 cells

BALB/c 3T3 cells can be transformed by transfection of an activated cellular oncogene as well as by chemicals. When the cells were transformed by pEJ-ras transfection, a marked increase in Mr 21,000 protein expression was found by Western blotting and immunohistochemical staining, whereas no such increase was detected in cells transformed by methylcholanthrene, suggesting two different molecular mechanisms. By directly microinjecting a fluorescent dye (Lucifer Yellow CH) into individual cells, we measured junctional intercellular communication among and between transformed and surrounding nontransformed cells. In both chemical and oncogene transformation studies, transformed cells and surrounding normal cells have similar capacities for gap-junctional communication, but there was complete lack of communication between transformed and nontransformed cells. When BALB/c 3T3 cells were transformed by methylcholanthrene initiation followed by phorbol ester promotion, again we saw no intercellular communication between transformed and nontransformed cells, suggesting that the observed selective communication block between transformed and nontransformed cells may be a general phenomenon in BALB/c 3T3 cells. These results indicate that selective lack of intercellular communication between transformed and surrounding normal cells may be an important phenomenon that separates transformed cells and nontransformed cells, permitting transformed cells to maintain autonomous growth.     

Immunohistochemical Expression of Blood Group Substances and Related Carbohydrate Antigens in Breast Carcinoma

In forty–one carcinomas and sixteen benign lesions (fibroadenoma and mastopathy) of the human breast, immunohistochemical expression of sialylated and non–sialylated forms of both Le^a and Le^x, and the A, B, and H type 2 blood group substances were studied by using an indirect immunoperoxidase staining. In normal ductal epithelium and benign lesion of breast, Lewis–related antigens were mostly expressed. Breast carcinomas showed these antigens with the following frequencies: Le^a, 31.7% (13/41); sialyl Le^a, 56.1% (23/41); Le^x, 46.3% (19/41); sialyl Le^x, 68.3% (28/41); A/B/H type 2, 38.1% (16/41). Sialylated forms of Le^a and Le^x were observed more frequently than their respective non–sialylated forms in breast carcinomas. In both one normal epithelium and four carcinomas of breast with Le^(a?b-) phenotype, the expressions of type 2 antigens were observed, while type 1 antigens were not consistently expressed. Although compatible expression was observed in all specimens of both normal epithelium and benign lesion of breast, twenty–four cases with the deletion of A and/or B antigens, six cases with H type 2 accumulation and one case with incompatible expression were demonstrated in breast carcinoma. Thirty–one breast carcinomas which showed the deletion of A/B/H type 2 expressed the Lewis–related antigens more frequently than nine cases which showed compatible expression. These results suggested that the activation of terminal fucosyltransferase and sialyltransferase as well as inactivation of some glycosyltransferases had occurred in cancer cell membrane, and sialyl Le¹, defined by a new monoclonal antibody CSLEX1, may be useful as a tumor–associated antigen independent of Lewis blood group type in breast cancer.     

Increased urinary excretion of collagen metabolites in cadmium-metallothionein nephropathy

In order to investigate the effect of cadmium-metallothionein (Cd-MT) on renal reabsorption of collagen metabolites, urinary excretion of hydroxylysine (Hyl), glucosyl-galactosyl-Hyl (Glc-Gal-Hyl), galactosyl-Hyl (Gal-Hyl), and hydroxyproline (Hyp), which are unique collagen metabolites, was determined in rats. Administration of Cd-MT resulted in acute renal failure in the form of proteinuria, aminoaciduria and glycosuria. Protein content in urine was greatly increased 1 day after injection of Cd-MT and decreased from 5 days, while the maximum levels of excretion of amino acids and glucose were observed at 6 days post-injection. The urinary excretion of total Hyp and Hyl, including Glc-Gal-Hyl, Gal-Hyl and free Hyl, were significantly increased at 3, 6 and 8 days after injection of Cd-MT with the maximum level at 6 days. Moreover, the molar ratio of Glc-Gal-Hyl/Gal-Hyl of urine in the Cd-MT-treated group was almost the same as that in the controls. These results suggest that a portion of Hyp, Hyl and its glycosides is normally reabsorbed from the renal tubule in the controls, and Cd-MT exposure caused an increase in urinary excretions of Hyp and Hyl, including its glycosides, through a renal tubular defect in reabsorption of Hyl in the same manner as with common amino acids.This work was presented in part at the Annual Meeting of the Pharmaceutical Society of Japan, Chiba, Japan, April 5, 1986     

Diarrhea and biogenic amines: regional changes in brain histamine concentration and serotonin metabolism following castor oil-induced diarrhea in rats]

Regional changes in concentrations of histamine (HA), serotonin (5-HT) and 5-hydroxyindoleacetic acid (5-HIAA) in the rat brain were investigated after diarrhea induced by castor oil. Significant decreases in body weight were observed from the 3rd day after daily oral administration of castor oil (2.5 ml/kg). HA concentrations in most brain regions decreased in diarrhea induced by a single administration of castor oil. A significant decrease was recognized particularly in the case of the hippocampus. The influence has begun to appear in the thalamus and hypothalamus in consecutive (3 d) administration. HA concentration in the striatal and hypothalamic regions of the rat treated with castor oil for 9 d significantly decreased in comparison with the control group. On the other hand, an inhibition of 5-HT turnover was observed in the thalamus at 3 h after a single administration of castor oil. However, this inhibition was not found in rats treated with castor oil for 3 d. Moreover, 5-HT concentration in the midbrain significantly decreased in rats that acquired the adaptability for the occurrence of diarrhea. These data present a new finding that the occurrence of diarrhea or acquisition of adaptability for diarrheal occurrence affects the central histaminergic or serotonergic neuron system.