Metastasis of extra-ampullary duodenal adenocarcinoma to the uterine cervix

Secondary metastatic tumours of the uterine cervix are rare. There have been no reports of duodenal cancer metastasizing to the uterine cervix. Here we present a rare case of an extra-ampullary duodenal adenocarcinoma that has metastasized to the uterine cervix. The patient was a 71-year-old woman who had surgery for an extra-ampullary duodenal adenocarcinoma five years previously. Follow-up examination revealed a suspicious right ovarian mass and nodules in the cervix and posterior fornix of the vagina. Biopsies suggested squamous cell carcinoma in the cervix and adenocarcinoma in the fornix. Intraoperatively, the right ovary was enlarged and peritoneal disseminations were found in the pouch of Douglas and the sigmoid colon mesentery. Histopathology of the subsequent hysterectomy and bilateral salpingo-oophorectomy specimen revealed a cervical squamous cell carcinoma categorized as pT1b1. Adenocarcinoma infiltration into the ovaries, uterine cervix and vagina, with vascular involvement was detected. Immunohistochemistry revealed the tumour in the cervix and ovaries to be positive for CK7, MUC5AC and MUC6, and immunonegative for CK20, CDX2, Pax8, ER, MUC2 and CD10, similar to the original duodenal adenocarcinoma. This case illustrates the difficulty in making a preoperative diagnosis of metastatic adenocarcinoma in the uterine cervix with a coexisting primary cervical squamous cell carcinoma. The absence of atypia in cervical glandular cells and immunohistochemical profiling of the adenocarcinoma clusters helped to reach a final diagnosis. This is the first report of an extra-ampullary duodenal adenocarcinoma metastasis to the uterine cervix.

Weight loss is associated with plasma free amino acid alterations in subjects with metabolic syndrome

OBJECTIVES

The prevalence of metabolic syndrome is increasing worldwide, especially in Asian populations. Early detection and effective intervention are vital. Plasma free amino acid profile is a potential biomarker for the early detection for lifestyle-related diseases. However, little is known about whether the altered plasma free amino acid profiles in subjects with metabolic syndrome are related to the effectiveness of dietary and exercise interventions.

METHODS

Eighty-five Japanese subjects who fulfilled the Japanese diagnostic criteria for metabolic syndrome were enrolled in a 3-month diet and exercise intervention. The plasma free amino acid concentrations and metabolic variables were measured, and the relationships between plasma free amino acid profiles, metabolic variables and the extent of body weight reduction were investigated. Those who lost more than 3% of body weight were compared with those who lost less than 3%.

RESULTS

Baseline levels of most amino acids in the subset that went on to lose <3% body weight were markedly lower compared with the counterpart, although both groups showed similar proportional pattern of plasma amino acid profiles. The weight loss induced by the diet and exercise intervention normalized plasma free amino acid profiles. For those with a high degree of weight loss, those changes were also associated with improvement in blood pressure, triglyceride and hemoglobin A1c levels.

CONCLUSIONS

These data suggest that among Japanese adults meeting the criteria for metabolic syndrome, baseline plasma free amino acid profiles may differ in ways that predict who will be more vs less beneficially responsive to a standard diet and exercise program. Plasma free amino acid profiles may also be useful as markers for monitoring the risks of developing lifestyle-related diseases and measuring improvement in physiological states.

Acute pancreatitis induced by paclitaxel and carboplatin therapy in an ovarian cancer patient

A 46-year-old female was treated with a regimen of paclitaxel and carboplatin (TC therapy) as adjuvant chemotherapy for Stage IC ovarian adenocarcinoma. There was no severe toxicity except for grade 3 neutropenia during the first four cycles of TC therapy. However, she developed acute pancreatitis at 14 days after fifth cycle. TC therapy is commonly associated with adverse effects such as myelosuppression, hypersensitivity, alopecia, and peripheral neuropathy, but acute pancreatitis has rarely been reported. Ovarian cancer patients often present with nausea and abdominal pain, which are the same symptoms of pancreatitis. It is very important to keep in mind that acute pancreatitis may be concealed in these common symptoms of ovarian cancer during and after TC therapy. Because acute pancreatitis is fatal complication and quitting the drug usually leads to complete cure. The authors report an uncommon case in which TC therapy may have caused acute pancreatitis.

Serous tubal intraepithelial carcinoma arising from the intrauterine portion of the fallopian tube after bilateral salpingo-oophorectomy

Serous tubal intraepithelial carcinoma (STIC) is considered the precursor of pelvic serous carcinomas and the earliest malignant alteration in BRCA mutation-positive women. Recently, risk-reducing salpingo-oophorectomy (RRSO) is being performed in BRCA mutation-positive women and STIC is often discovered incidentally in the fallopian tubes. A 62-year-old woman underwent bilateral salpingo-oophorectomy (BSO) for ovarian cysts. Ten months later, cytological screening for the endometrium revealed adenocarcinoma. No atypical tissue was detected by the endometrial curettage. Imaging tests and hysteroscopy found no abnormal findings. She underwent hysterectomy and was diagnosed with STIC originating from the intrauterine portion of the residual fallopian tube. Here, the authors report the first case of STIC being detected during an endometrial cytological examination after BSO. Although STIC associated with the BRCA mutation usually involves the distal fallopian tube, the present case suggests that the intrauterine portion of the fallopian tube should be removed or cauterized during RRSO.

A comprehensive substance flow analysis of a municipal wastewater and sludge treatment plant

The fate of total organic carbon, 32 elements (Al, Ag, As, Ba, Be, Br, Ca, Cd, Cl, Co, Cr, Cu, Fe, Hg, K, Li, Mg, Mn, Mo, N, Na, Ni, P, Pb, S, Sb, Se, Sn, Sr, Ti, V, and Zn) and 4 groups of organic pollutants (linear alkylbenzene sulfonates, bis(2-ethylhexyl)phthalate, polychlorinated biphenyl and polycyclic aromatic hydrocarbons) in a conventional wastewater treatment plant were assessed. Mass balances showed reasonable closures for most of the elements. However, gaseous emissions were accompanied by large uncertainties and show the limitation of mass balance based substance flow analysis. Based on the assessment, it is evident that both inorganic and organic elements accumulated in the sewage sludge, with the exception of elements that are highly soluble or degradable by wastewater and sludge treatment processes. The majority of metals and metalloids were further accumulated in the incineration ash, while the organic pollutants were effectively destroyed by both biological and thermal processes. Side streams from the sludge treatment process (dewatering and incineration) back to the wastewater treatment represented less than 1% of the total volume entering the wastewater treatment processes, but represented significant substance flows. In contrast, the contribution by spent water from the flue gas treatment process was almost negligible. Screening of human and eco-toxicity by applying the consensus-based environmental impact assessment method USEtox addressing 15 inorganic constituents showed that removal of inorganic constituents by the wastewater treatment plant reduced the toxic impact potential by 87-92%.

Blockade of interleukin-6 receptor enhances the anti-arthritic effect of glucocorticoids without decreasing bone mineral density in mice with collagen-induced arthritis

In a mouse arthritis model, we investigated whether interleukin-6 receptor (IL-6R) blockade would enhance the anti-arthritic effect of glucocorticoids (GCs). DBA/1J mice were immunized with type II collagen (CII), and were treated with prednisolone (PSL) and/or anti-mouse IL-6R antibody (MR16-1). Also, the effects of IL-6 on gene expression and the nuclear translocation of glucocorticoid receptors (GRs) were examined in cultured cells treated with dexamethasone (DEX). PSL reduced the arthritis score dose-dependently in the collagen-induced arthritis (CIA) mouse model. The arthritis score in the PSL (3 mg/kg) + MR16-1 group was lower than in the PSL (3 mg/kg) group, and at the same level as in the PSL (6 mg/kg) group. Lumbar vertebra bone mineral density (BMD) was decreased significantly in CIA mice and was higher in the PSL (3 mg/kg) + MR16-1 group than in the PSL (6 mg/kg) group. In the in-vitro synovial cells, IL-6 pretreatment attenuated the inhibitory effect of DEX on cyclooxygenase (COX)-2 expression and inhibited the nuclear translocation of GR induced by DEX. In contrast, in MC3T3-E1 osteoblastic cells, IL-6 pretreatment exacerbated the decrease in expression of osteocalcin and the increase in expression of receptor activator of nuclear factor kappa-B ligand (RANKL) by DEX. We demonstrated that IL-6 signalling blockade by an anti-IL-6R antibody can augment the anti-arthritic effect of GCs and inhibit the bone loss they cause.

Serum 25-hydroxyvitamin D level and risk of falls in Japanese community-dwelling elderly women: a 1-year follow-up study

The present prospective follow-up study among 1,393 community-dwelling elderly women aged 75 years or older was conducted to clarify the association between serum 25-hydroxyvitamin D (25(OH)D) level and risk of falls. Lower serum 25(OH)D, particularly level <20 ng/mL, was significantly associated with an increased risk of falls.

INTRODUCTION

Serum 25(OH)D level has been revealed to be important factor not only for skeletal health but also for fall prevention among the elderly. Our previous cross-sectional study indicated that low serum 25(OH)D level is associated with inferior physical performance and falls among elderly Japanese women. The present prospective study was designed to clarify the association between serum 25(OH)D level and risk of falls before and after 1 year of follow-up.

METHODS

The community-dwelling elderly women aged 75 years or older (N = 1,393) who participated in a mass health examination were followed 1 year later by a mailed self-administered questionnaire.

RESULTS

Responses were obtained from 1,285 subjects (response rate = 92.2%). The incidence of falls at baseline and at 1-year follow-up was 18.8 and 24.4%, respectively. The baseline prevalence of serum 25(OH)D <20 ng/mL was 35.2%. Odds ratios (95% confidence intervals) in the lowest tertile of serum 25(OH)D (<20 ng/mL) compared with those in the highest tertile (≥25 ng/mL) were 1.40 (1.01-1.94) for any falls and 1.47 (0.93-2.32) for recurrent falls vs. no falls adjusted for potential risk factors.

CONCLUSIONS

Among elderly Japanese women, the lower serum 25(OH)D, particularly level <20 ng/mL, was significantly associated with an increased risk of falls.

Fluency-dependent cortical activation associated with speech production and comprehension in second language learners

This functional magnetic resonance imaging (fMRI) study investigated the brain regions underlying language task performance in adult second language (L2) learners. Specifically, we identified brain regions where the level of activation was associated with L2 fluency levels. Thirty Japanese-speaking adults participated in the study. All participants were L2 learners of English and had achieved varying levels of fluency, as determined by a standardized L2 English proficiency test, the Versant English Test (Pearson Education Inc., 2011). When participants performed the oral sentence building task from the production tasks administered, the dorsal part of the left inferior frontal gyrus (dIFG) showed activation patterns that differed depending on the L2 fluency levels: The more fluent the participants were, the more dIFG activation decreased. This decreased activation of the dIFG might reflect the increased automaticity of a syntactic building process. In contrast, when participants performed an oral story comprehension task, the left posterior superior temporal gyrus (pSTG) showed increased activation with higher fluency levels. This suggests that the learners with higher L2 fluency were actively engaged in post-syntactic integration processing supported by the left pSTG. These data imply that L2 fluency predicts neural resource allocation during language comprehension tasks as well as in production tasks. This study sheds light on the neural underpinnings of L2 learning by identifying the brain regions recruited during different language tasks across different modalities (production vs. comprehension).

Three-dimensional positioning and control of colloidal objects utilizing engineered liquid crystalline defect networks

Topological defects in liquid crystals not only affect the optical and rheological properties of the host, but can also act as scaffolds in which to trap nano or micro-sized colloidal objects. The creation of complex defect shapes, however, often involves confining the liquid crystals in curved geometries or adds complex-shaped colloidal objects, which are unsuitable for device applications. Using topologically patterned substrates, here we demonstrate the controlled generation of three-dimensional defect lines with non-trivial shapes and even chirality, in a flat slab of nematic liquid crystal. By using the defect lines as templates and the electric response of the liquid crystals, colloidal superstructures are constructed, which can be reversibly reconfigured at a voltage as low as 1.3 V. Three-dimensional engineering of the defect shapes in liquid crystals is potentially useful in the fabrication of self-healing composites and in stabilizing artificial frustrated phases.

Topological defects can be used not only to modify the properties of liquid crystals but also as scaffolds to build new structures by trapping particles. Here, Yoshida et al. construct three-dimensional colloidal superstructures in a nematic host, which are reconfigurable in an electric field.

Frequent MED12 mutations in phyllodes tumours of the breast

BACKGROUND

Phyllodes tumours are rare fibroepithelial tumours of the breast, that include benign, borderline, and malignant lesions. Although the molecular basis of phyllodes tumours largely remains unknown, a recent exome study identified MED12 mutations as a sole recurrent genetic alteration in fibroadenoma, a common benign fibroepithelial tumour that shares some histological features with the phyllodes tumour.

METHODS

Forty-six phyllodes tumours and 58 fibroadenomas of the breast were analysed for MED12 mutations by using Sanger sequencing.

RESULTS

MED12 mutations were identified in 37 out of the 46 phyllodes tumours (80%). The prevalence of MED12 mutations was similar among benign (15/18, 83%), borderline (12/15, 80%), and malignant tumours (10/13, 77%). MED12 mutations were also identified in 36 of the 58 fibroadenomas (62%). The mutations were frequent among intracanalicular-type (24/32, 75%) and complex-type lesions (4/6, 67%), but were significantly less common among the pericanalicular-type lesions (8/20, 40%). A microdissection-based analysis showed that MED12 mutations were confined to the stromal components in both phyllodes tumours and fibroadenomas.

CONCLUSIONS

MED12 mutations were frequent among the phyllodes tumours of the breast, regardless of the tumour grade. Phyllodes tumours and fibroadenomas share, at least in part, a common genetic background.

Borylstannylation of alkynes with inverse regioselectivity: copper-catalyzed three-component coupling using a masked diboron

Masked boryl and stannyl moieties are smoothly installed into a carbon–carbon triple bond of diverse terminal alkynes under copper catalysis to provide cis-boryl(stannyl)alkenes in a straightforward manner. The regioselectivity is totally inverted to those of the previous borylstannylations, where a masked boryl moiety is attached to an internal carbon of alkynes.

Inverse regioselectivity in the silylstannylation of alkynes and allenes: copper-catalyzed three-component coupling with a silylborane and a tin alkoxide

Three-component silylstannylation of alkynes and allenes has been found to take place facilely by use of a silylborane and a tin alkoxide under copper catalysis. The regioselectivities become totally inverse to those of the previous palladium-catalyzed silylstannylation.

Copper-catalyzed α-selective hydrostannylation of alkynes for the synthesis of branched alkenylstannanes

A universal system for highly α-selective hydrostannylation of terminal alkynes has been developed by use of a distannane or a silylstannane as a stannylating reagent under copper catalysis.

Dock3 protects myelin in the cuprizone model for demyelination

Dedicator of cytokinesis 3 (Dock3) belongs to an atypical family of the guanine nucleotide exchange factors. It is predominantly expressed in the neural tissues and causes cellular morphological changes by activating the small GTPase Rac1. We previously reported that Dock3 overexpression protects retinal ganglion cells from excitotoxic cell death. Oligodendrocytes are the myelinating cells of axons in the central nervous system and these cells are damaged in demyelinating disorders including multiple sclerosis (MS) and optic neuritis. In this study, we examined if Dock3 is expressed in oligodendrocytes and if increasing Dock3 signals can suppress demyelination in a cuprizone-induced demyelination model, an animal model of MS. We demonstrate that Dock3 is expressed in oligodendrocytes and Dock3 overexpression protects myelin in the corpus callosum following cuprizone treatment. Furthermore, we show that cuprizone demyelinates optic nerves and the extent of demyelination is ameliorated in mice overexpressing Dock3. Cuprizone treatment impairs visual function, which was demonstrated by multifocal electroretinograms, an established non-invasive method, and Dock3 overexpression prevented this effect. In mice overexpressing Dock3, Erk activation is increased, suggesting this may at least partly explain the observed protective effects. Our findings suggest that Dock3 may be a therapeutic target for demyelinating disorders including optic neuritis.

Randomized clinical trial: rikkunshito in the treatment of functional dyspepsia--a multicenter, double-blind, randomized, placebo-controlled study

BACKGROUND

Rikkunshito, a standardized Japanese herbal medicine, is thought to accelerate gastric emptying and relieve dyspepsia, although no large-scale, randomized, placebo-controlled trials of rikkunshito have been conducted. This study aimed to determine the efficacy and safety of rikkunshito for treating functional dyspepsia (FD).

METHODS

FD patients received 2.5 g rikkunshito or placebo three times a day for 8 weeks in this multicenter, randomized, placebo-controlled, parallel-group trial. The primary end point was the proportion of responders at 8 weeks after starting test drug, determined by global patient assessment (GPA). The improvement in four major dyspepsia symptoms severity scale was also evaluated. In addition, plasma ghrelin levels were investigated before and after treatment.

KEY RESULTS

Two hundred forty-seven patients were randomly assigned. In the eighth week, the rikkunshito group had more GPA responders (33.6%) than the placebo (23.8%), although this did not reach statistical significance (p = 0.09). Epigastric pain was significantly improved (p = 0.04) and postprandial fullness tended to improve (p = 0.06) in the rikkunshito group at week 8. Rikkunshito was relatively more effective among Helicobacter pylori-infected participants (rikkunshito: 40.0% vs placebo: 20.5%, p = 0.07), and seemed less effective among H. pylori-uninfected participants (rikkunshito: 29.3% vs placebo: 25.6%, p = 0.72). Among H. pylori-positive individuals, acyl ghrelin levels were improved just in rikkunshito group. There were no severe adverse events in both groups.

CONCLUSIONS & INFERENCES

Administration of rikkunshito for 8 weeks reduced dyspepsia, particularly symptoms of epigastric pain and postprandial fullness. (UMIN Clinical Trials Registry, Number UMIN000003954).

Field-Swept NMR Spectra of 11B in Pyrex Glass and 93Nb in NbN Perturbed by Quadrupole Interaction

NMR experiments of 11B by both field-swept and high-resolution NMR are reported to probe the electric field gradient at boron sites and its distribution in Pyrex glass. Both spectra are successfully interpreted with the same set of parameters. It is stressed that field-swept NMR experiments to observe total powder spectrum can be helpful to get information on electric field gradients and asymmetry pa-rameters if there exist many nonequivalent sites of atoms, since satellite transitions are affected by the larger first-order quadrupole effect. Field-swept NMR of 93Nb in superconducting NbN powder, prepared by self-propagating high-temperature synthesis, is also reported. A very broad field-swept spectrum disturbed by quadrupole interaction has been observed. The spectrum is simulated by assuming distributions in electric field gradient and Knight shift at Nb sites. It is stressed that a combination of experiments at separated frequencies is important.

Case report of FLT3-ITD-positive AML patient 11 years after living donor liver transplantation

With the increasing number of long-term survivors of living donor liver transplantation, the occurrence of secondary cancer is sometimes reported. Solid tumors such as lymphomas are mainly observed. However, only 8 cases of leukemia have been reported so far. For patients younger than 15 years old, leukemia developed in 4 within 3 years after the liver transplantation, whereas acute lymphoblastic leukemia developed in only 1 patient. This is the first case report of a patient in whom FLT3-ITD-positive acute myeloid leukemia (AML) developed more than 10 years after living donor liver transplantation for congenital biliary atresia. AML developed in a 14-year-old boy 11 years after living donor liver transplantation from his father. The patient received the transplant at the age of 3 years and was treated with tacrolimus and methylprednisolone for transplant rejection. Eleven years posttransplantation, he visited the hospital with general malaise and anemia. Blood tests revealed an elevated white blood cell count of 60,100/μL, and the patient was diagnosed with AML. Chromosome analysis revealed a t(6; 9) (p23 q34) translocation; moreover, genetic testing revealed a FLT3-ITD-positive mutation. We started treatment in accordance with the Tokyo Children's Cancer Study Group AML99 protocol. With chemotherapy treatment, the patient achieved complete remission. After chemotherapy, we performed stem cell transplantation from his father. Other patients were reported in relatively early stages after liver transplantation, but our case was more than 10 years posttransplantation. The association with the onset of congenital bile duct atresia and leukemia is still not clear, but we consider the possibility that long-term immunosuppressive drugs contribute to developing leukemia.

Drosophila myeloid leukemia factor acts with DREF to activate the JNK signaling pathway

Drosophila myelodysplasia/myeloid leukemia factor (dMLF), a homolog of human MLF1, oncogene was first identified by yeast two-hybrid screen using the DNA replication-related element-binding factor (DREF) as bait. DREF is a transcription factor that regulates proliferation-related genes in Drosophila. It is known that overexpression of dMLF in the wing imaginal discs through the engrailed-GAL4 driver causes an atrophied wing phenotype associated with the induction of apoptosis. However, the precise mechanisms involved have yet to be clarified. Here, we found the atrophied phenotype to be suppressed by loss-of-function mutation of Drosophila Jun N-terminal kinase (JNK), basket (bsk). Overexpression of dMLF induced ectopic JNK activation in the wing disc monitored with the puckered-lacZ reporter line, resulting in induction of apoptosis. The DREF-binding consensus DRE sequence could be shown to exist in the bsk promoter. Chromatin immunoprecipitation assays in S2 cells with anti-dMLF IgG and quantitative real-time PCR revealed that dMLF binds specifically to the bsk promoter region containing the DRE sequence. Furthermore, using a transient luciferase expression assay, we provide evidence that knockdown of dMLF reduced bsk gene promoter activity in S2 cells. Finally, we show that dMLF interacts with DREF in vivo. Altogether, these data indicate that dMLF acts with DREF to stimulate the bsk promoter and consequently activates the JNK pathway to promote apoptosis.

Dextromethorphan for neuropathic pain with Churg-Strauss syndrome

Abstract A 48-year old man who had been treated with prednisolone, aminophylline, and pranlukast, a leukotriene-receptor antagonist, was diagnosed with Churg-Strauss syndrome based on the findings of asthma, eosinophilia, mononeuropathy, and extravascular eosinophils. Intractable neuropathic pain of the legs was successfully controlled with an N-methyl-d-aspartate receptor antagonist, dextromethorphan. We suggest that dextromethorphan receptor antagonists may be a useful treatment for the pain of neuropathy caused by vasculitis syndrome.