Study of the usefulness of large intestine screening inspections using multi-slice CT (MSCT)

CT-colonography (CT-C), a new diagnostic imaging technique for cancer of the large intestine--which is increasing rapidly owing to westernized eating habits--has advanced from the developmental stage to the stage of practical application, thanks to progress in MSCT and workstation development. Therefore, based on the results of CT-C application using 16 lines of MSCT to a screening test, we reviewed the usefulness of CT-C in our clinic. We supplemented defective depiction, and found that change of position was effective for virtual image exclusion. We consider that CT-C can support diagnosis if the target of screening tests is a polypoid lesion of more than 6 mm. In addition, it is expected that the number of examinations performed during office visits will increase because of the decreased invasiveness of the procedure, its lack of pain, and its ability to provide early lesion detection.     

Short and long-term hypotensive effect of timolol-gel and latanoprost instillation in normal-tension glaucoma

PURPOSE: To confirm the predictive value of the results of a 4-week trial of latanoprost alone, timolol-gel alone, or a combination of the two in normal-tension glaucoma (NTG) patients, when compared with the hypotensive response after a 6-month trial using the same combination of eye drops for the same patients. METHODS: One eye each of 45 NTG patients was used in a prospective 4-week trial of latanoprost alone, timolol-gel alone, or a combination of the two. Patients continued using the eye drops for 6 months, according to the results of the trial. The correlation of the results of the 6-moth use and the baseline data, and the baseline data and the results of the 4-week trial were evaluated by the paired-t test. RESULTS: The intraocular pressure(IOP)s of patients using timolol-gel alone were 13.9 mmHg at the base line, 9.7 mmHg after the trial, and 12.0 mmHg after 6-month use(baseline, trial: p < 0.05). IOPs when using latanoprost alone were 15.3 mmHg at baseline, 11.7 mmHg after the trial, and 11.5 mmHg after 6-month use(baseline: p < 0.05, trial: p = 0.33). IOPs using timolol-gel and latanoprost in combination were 14.8 mmHg at baseline, 11.4 mmHg after the trial, and 12.0 mmHg after 6-month use (baseline: p < 0:05, trial: p = 0.14). CONCLUSION: The result of the 4-weeks trial of latanoprost alone or in combination with timolol-gel can be indicative of the IOP after 6-month use.     

Co-expression of CD44v3 and heparanase is correlated with metastasis of human colon cancer

Heparanase is an enzyme that degrades extracellular glycoprotein to release heparan sulfate molecules. CD44 variant exon 3 (CD44v3), a receptor for heparan sulfate, generates intracellular signals for cell migration. Production of CD44v3 and expression of heparanase were detected by immunohistochemistry and in situ hybridization, respectively. In 145 cases of colon cancer, heparanase mRNA and CD44v3 protein were detected in 46% and 43%, respectively. Co-expression of heparanase and CD44v3 was found in cases of 12% of Dukes' B, 32% of Dukes' C, and 57% of Dukes' D cases. Survival analysis found a significantly poorer prognosis in patients showing concurrent expression of heparanase and CD44v3 than in patients not showing both (p<0.0001). Concurrent expression of heparanase and CD44v3 might be a mechanism of cancer invasion and metastasis in colon cancer.     

The effect of fibroblast growth factor-2 on the osteoinductive activity of recombinant human bone morphogenetic protein-2 in rat muscle

To clarify the effect of recombinant human basic fibroblast growth factor (FGF-2) on the osteoinductive activity of recombinant human bone morphogenetic protein-2 (BMP-2) in vivo, different amounts of FGF-2 (0, 16, 80 and 400 ng, and 2, 10 and 50 micro g: n=10 in each group), BMP-2 (2 micro g) and type I collagen as a carrier were mixed and implanted into rat calf muscles. Three weeks after implantation, compared with the controls, the radiopaque shadows of the implants were increased in the 16, 80 and 400 ng FGF-2-treated groups, but decreased in the 2, 10 and 50 micro g FGF-2-treated groups. In addition, alkaline phosphatase activity was increased in the 16, 80 and 400 ng FGF-2-treated groups but decreased in the 50 micro g FGF-2-treated group. Histological examination revealed increased bone formation in the 16, 80 and 400 ng FGF-2-treated groups. These results show that combined treatment with FGF-2 and BMP-2 has a biphasic effect on osteoinductive activity, i.e. it increases with low doses of FGF-2 and decreases with high doses of FGF-2.     

Profile of gene expression in the subventricular zone after traumatic brain injury

Neural stem cells, which reside in the subventricular zone (SVZ) and dentate gyrus (DG) of adult mammals, give rise to new neurons throughout life. However, these neural stem cells do not appear to contribute to regeneration in the damaged central nervous system. Following traumatic brain injury (TBI) in adult rats, the number of proliferating cells labeled with bromodeoxyuridine (BrdU) is significantly increased in the bilateral SVZ and DG; however, these proliferating cells do not contribute to effective regeneration in the damaged area. To gain insight into the molecular mechanisms of these biological actions, changes in gene expression in the SVZ after brain trauma were examined by cDNA microarray. Of 9,596 genes screened, 97 were upregulated and 204 were downregulated. Classifying these genes according to their function suggests that TBI affects a broad range of cellular functions. The validity of the data was confirmed by RT-PCR. The expression of some genes localized in the SVZ was confirmed by in situ hybridization. This combined strategy is effective for comprehensive analysis of the pathophysiological changes in the SVZ after brain injury and should contribute to the understanding of the molecular events that occur after injury. In the future, this may enable regeneration of the damaged central nervous system.     

Cost-effectiveness of adjunctive hyperbaric oxygen in the treatment of diabetic ulcers

OBJECTIVES: This study estimates the cost-effectiveness (CE) of the adjunctive use of hyperbaric oxygen (HBO2) therapy in the treatment of diabetic ulcers based on the payer's and societal perspectives. METHODS: The study population was a hypothetical cohort of 1,000 patients sixty years of age with severe diabetic foot ulcers. A decision tree model was constructed to estimate the CE of HBO2 therapy in the treatment of diabetic ulcers at years 1, 5, and 12. Scenario and one-way sensitivity analyses were also undertaken to identify parameters that may significantly influence the estimates. RESULTS: The CE model estimated that the incremental cost per additional quality-adjusted life year (QALY) gained at years 1, 5, and 12, was dollar 27,310, dollar 5,166, and dollar 2,255, respectively. CONCLUSIONS: The study results indicate that HBO2 therapy in the treatment of diabetic ulcers is cost-effective, particularly based on a long-term perspective. However, the results are limited by the clinical studies that provide the basis of the CE estimation.     

A prospective comparison between multidetector-row computed tomography and magnetic resonance imaging in the preoperative evaluation of rectal carcinoma

BACKGROUND: Multidetector-row computed tomography (MDCT, or multislice CT) is a new modality with four detectors, which makes examination time shorter and produces higher resolution and multiplanar reformation of the images. Its diagnostic role in patients with rectal carcinoma has not been determined. METHODS: Twenty-one patients with rectal carcinoma were preoperatively examined by both MDCT and magnetic resonance imaging (MRI). Diagnostic accuracies of both modalities were compared regarding depth of tumor invasion and lymph node metastasis based on the pathologic findings. RESULTS: Both examinations detected all tumors. Regarding depth of tumor invasion, the concordance was 95.2% (20 of 21) for MDCT and 100% (21 of 21) for MRI. Regarding lymph node metastasis, the overall accuracy was 61.9% for MDCT and 70.0% for MRI. CONCLUSIONS: Multidetector-row computed tomography was equal to MRI in the preoperative local staging of rectal carcinoma.     

The effects of clonidine premedication on the blood pressure and tachycardiac responses to ephedrine in elderly and young patients during propofol anesthesia

We studied the pressor and tachycardiac responses to ephedrine in elderly and young patients given either clonidine or midazolam during propofol anesthesia. In the first experiment, elderly (>60 yr) and young (20-45 yr) patients were randomly allocated to one of four groups according to age and premedicated regimens (n = 16 each; elderly-clonidine [EC], elderly-midazolam [EM], young-clonidine [YC], and young-midazolam [YM]). Under propofol anesthesia, ephedrine was injected, and hemodynamic measurements were made. In the second experiment, with clonidine premedication, elderly patients (n = 16) were given a reduced dose of propofol (EC-LP) and young patients (n = 16) were given an increased dose of propofol (YC-HP). Ephedrine was injected, and he- modynamic measurements were performed. The in-creases in mean blood pressure and heart rate were larger in the EC group than in the EM, YM, and EC-LP groups (P < 0.05). In the YC-HP group, the pressor response to ephedrine tended to be augmented as compared with the YC group but was not statistically significant. These results suggest that clonidine premedication augmented the pressor and tachycardiac responses to ephedrine, especially in elderly patients during a standard dose of propofol anesthesia, and that clonidine, age, and propofol could be involved in the augmentation of the blood pressure and tachycardiac responses to ephedrine. IMPLICATIONS: Clonidine premedication augments the pressor and tachycardiac responses to ephedrine in elderly patients during standard or large doses of propofol anesthesia but does not augment during small doses of propofol anesthesia. Clonidine, age, and propofol could be involved in the augmentation of the pressor and tachycardiac responses to ephedrine.     

Potent activity of soluble B7RP-1-Fc in therapy of murine tumors in syngeneic hosts

We have characterized a receptor:ligand pair, ICOS:B7RP-1, that is structurally and functionally related to CD28:B7.1/2. We reported previously that B7RP-1 costimulates T cell proliferation and immune responses (Yoshinaga et al., Nature 1999;402:827-32; Guo et al., J Immunol 2001;166:5578-84; Yoshinaga et al., Int Immunol 2000;12:1439-47). We report that B7RP-1-Fc causes rejection or growth inhibition of Meth A, SA-1 and EMT6 tumors in syngeneic mice. Established Meth A tumors were rejected effectively with a single dose of B7RP-1-Fc, however, the treatment was less effective on larger tumors. Mice that rejected Meth A tumors previously by Day 30, also rejected a subsequent Meth A challenge on Day 60, without additional B7RP-1-Fc treatment, indicating a long-lived memory response. Tumor cells believed to be less immunogenic, such as P815 and EL-4 cells, were less responsive to this treatment. The EL-4 responsiveness to the B7RP-1-Fc treatment was enhanced, however, by pre-treatment of the mice with cyclophosphamide. As expected, T cells appeared to be targeted by B7RP-1-Fc treatment. Thus, the administration of soluble B7RP-1-Fc may have therapeutic value in generating or enhancing anti-tumor activity in a clinical setting.