Effects of epidermal growth factor on the invasion activity of the oral cancer cell lines HSC3 and SAS

Epidermal growth factor (EGF) is excreted in a high concentration in human saliva and modulates the growth and differentiation of various cancer cells. To elucidate the molecular mechanisms by which EGF affects oral cancer growth and invasion, we analyzed the Matrigel invasion activity of the cultured oral cancer cell line. Cells grown under the influence of EGF were subjected to Matrigel invasion assays and cells grown in the absence of EGF were used as controls. Gelatin-zymography and Northern blot analyses quantified the invasiveness and tumorigenicity. Chloramphenicol acetyltransferase assay (CAT assay) determined the EGF stimulation of matrix metalloproteinase (MMP) expression. EGF increased the number of cells penetrating a Matrigel membrane. Gelatin-zymography and Northern blot analysis revealed that MMP9 and Ets1 expressions correlated with EGF but MMP2 was not changed. a transient transfection assay revealed that EGF increased the promoter activities of the MMP9 genes in HSC3 and SAS cells. These results suggest that EGF increases the invasion activity of oral cancer cells partly by increasing MMP9

Upper arm central venous port implantation: a 6-year single institutional retrospective analysis and pictorial essay of procedures for insertion.

The requirement of central venous (CV) port implantation is increasing with the increase in the number of cancer patients and advancement in chemotherapy. In our division, medical oncologists have implanted all CV ports to save time and consultation costs to other departments. Recently, upper arm implantation has become the first choice as a safe and comfortable method in our unit. Here we report our experience and discuss the procedure and its potential advantages.All CV port implantations (n = 599) performed in our unit from January 2006 to December 2011 were analyzed. Procedural success and complication rates between subclavian and upper arm groups were compared.Both groups had similar patient characteristics. Upper arm CV port and subclavian implantations were equivalently successful and safe. Although we only retrospectively analyzed data from a single center, the upper arm group had a significantly lower overall postprocedural complication rate than the subclavian group. No pneumothorax risk, less risk of arterial puncture by ultrasound, feasibility of stopping potential arterial bleeding, and prevention of accidental arterial cannulation by targeting the characteristic solitary basilic vein were the identified advantages of upper arm CV port implantation. In addition to the aforementioned advantages, there is no risk of "pinch-off syndrome," possibly less patient fear of manipulation, no scars on the neck and chest, easier accessibility, and compatibility with the "peripherally inserted central catheter" technique.Upper arm implantation may benefit clinicians and patients with respect to safety and comfort. We also introduce our methods for upper arm CV port implantation with the videos

Proportion of Success and Complications.

†<p>Total parenteral nutrition was administered in all cases.</p

Preparation.

<p>(<b>A</b>) <b>Minimum specific materials for the procedure.</b> In this kit, a CV port/catheter, a dilator sheath, and a guide wire are supplied. For venipuncture, we use common peripheral intravenous catheters with appropriate lengths and gauge sizes through which a guide wire can be passed. In this kit, an 18-gauge needle is sufficient. In case of “Seldinger technique”-based kits, a 20- or 22-gauge needle might be sufficient because those guide wires are usually thinner than “peel-off sheath”-based kits. Further, commonly used materials such as surgical caps, masks, eye protection, sterile gloves, gowns, drapes, disinfectant sponges, gauzes, sutures with needles, scalpels, anesthetic syringes, and 1% or 2% lidocaine anesthetic solutions are also required (not shown). (<b>B</b>) <b>Arm position.</b> The patient should be asked to lie down in the supine position, which allows the upper limb to abduct, upper arm to rotate outward, forearm to supinate, and medial side of the arm to be upward for better demonstration of the basilic vein. The elbow should not be bent, and the forearm should not be pronated. (<b>C</b>) <b>Tips for applying the probe with the correct angle.</b> The probe should be applied at the correct angle.</p

Port Implantation.

<p>(<b>A</b>) <b>Skin incision.</b> A scalpel should be used to make a skin incision from 2 cm to the right to 2 cm to the left of the puncture point. This incision should be used later as the entrance for making a subcutaneous pocket with a forceps. (<b>B</b>) <b>Making a slit between the skin and wire.</b> The connective tissues between the skin and wire should be cut with a scalpel to make a slit a few millimeters long over the wire in the puncture point. (<b>C</b>) <b>The purpose of a slit.</b> Without this step, the catheter route will be shallower from the skin surface; subsequently, the risk of catheter exteriorization will increase.</p

Characteristics of the Patients.

<p>Characteristics of the Patients.</p

Real-time ultrasound-guided venipuncture.

<p>(<b>A</b>) <b>“Two-person method” and “one-person method.”</b> With the “two-person method,” the ultrasound-guidance step and the puncturing step are assigned separately to two operators. This can increase the success rate for beginners. (<b>B</b>) <b>Tips for puncture with the correct angle.</b> The axes between the probe and needle must be kept in one line.</p

Images of postprocedural complications that could be prevented with an upper arm CV port.

<p>(<b>A</b>) <b>Catheter pinch-off syndrome and fracture. </b><i>Arrow</i> indicates a “pinched-off” and fractured site of a catheter. <i>Arrowheads</i> indicate the fractured distal catheter fragments that had migrated into the pulmonary artery through the heart. (<b>B</b>) <b>Catheter inversion.</b> Left panel, <i>Arrow</i> indicates a normal catheter placed centrally. Note that there is a sweep turning point at this puncture site that may cause tension derived from an elastic restoring force. Right panel, <i>Arrowheads</i> indicate the peripherally inverted distal portion of a catheter for the same case.</p

Examples of anticipated preoperative difficulties with the procedure confirmed on CT scan images.

<p>(<b>A</b>) <b>SVC syndrome.. </b><i>Arrow</i> indicates the excluded SVC by a tumor. (<b>B</b>) <b>Tortuous collateral blood circulation.. </b><i>Arrows</i> indicate the contrast-enhanced tortuous collateral blood circulation attributable to a modification caused by surgery, radiation, or spontaneous occlusion.</p