The prognostic significance of vasohibin-1 expression in patients with prostate cancer

Background:

We recently isolated vasohibin-1 (VASH1), a novel angiogenic molecule that is specifically expressed in activated vascular endothelial cells (ECs), and the status of VASH1 expression has been documented in various cancer angiogenesis. The aim of this study was to assess the prognostic value of VASH1 expression in prostate cancer (PCa).

Methods:

In this study, we retrospectively analysed the clinical records and evaluated the VASH1 expression of tumour microvessels in 167 patients with PCa who underwent radical prostatectomy. We immunohistochemically examined the microvessels positive for anti-CD34 as microvessel density (MVD) and the microvessels with activated ECs positive for VASH1 density.

Results:

We found that the VASH1 expression was restricted to ECs in the tumour stroma. VASH1 density was significantly associated with pathological T stage, Gleason score and MVD. The 5-year PSA recurrence-free survival rate was 58.8% in patients with higher VASH1 density (≧12 per mm²) and 89.1% in patients with lower VASH1 density (<12 per mm²), respectively (P<0.001). Microvessel density was not an independent predictor of PSA recurrence. Multivariate analysis revealed that high VASH1 density was an independent prognostic indicator of PSA recurrence (P=0.007, HR=2.950).

Conclusion:

VASH1 density represents a clinically relevant predictor of patient prognosis and can be a new biomarker that would provide additional prognostic information in PCa.

Abstract 2429: Airway necrosis after salvage esophagectomy

Background: Recently definitive chemoradiotherapy (CRT) without surgery has been accepted as an alternative treatment for esophageal cancer. However, unfortunately, the tumors of 5-33% patients were resistant to CRT and persistent disease was detected soon after treatment, and 16-54% patients initially showed a response but locoregional disease was discovered later. Salvage esophagectomy is the sole curative intent treatment for patients with persistent or recurrent locoregional disease after definitive CRT for esophageal carcinoma. However, salvage esophagectomy is a very high-risk operation, and airway necrosis is a fatal complication.

Methods: Between 1997 and 2007, 49 patients with thoracic esophageal squamous cell carcinoma underwent salvage esophagectomy after definitive CRT. All patients received more than 50 Gy of radiation plus concurrent chemotherapy for curative intent. We retrospectively compared patients with and without airway necrosis. Additionally, airway necrosis was categorized primary necrosis and secondary necrosis according to the cause of necrosis, and operative procedures related to airway necrosis were investigated.

Result: Overall 23of 49 patients had at least one complication (morbidity: 46.9%), and 5 died during their hospitalization (mortality: 10.2%). Airway necrosis occurred in five patients (10.2%), of four patients (80%) died during their hospitalization. Airway necrosis seemed to be closely related to operative procedures, such as resection of bronchial artery (BA), cervical and subcarinal lymph node dissection (LND) and reconstruction route. Primary necrosis occurred in 3 patients with resection of BA, cervical LND, or subcarinal LND. And bronchogastric fistula following necrosis of gastric conduit occured in 2 patients reconstructed through posterior mediastinal route.

Conclusions: Airway necrosis is a highly lethal complication after salvage esophagectomy. It is important in salvage esophagectomy to take airway blood supply into consideration sufficiently and to reconstruct through retrosternal route to prevent bronchogastric fistula.

Citation Format: Norimitsu Tanaka, Nobukazu Hokamura, Yuji Tachimori. Airway necrosis after salvage esophagectomy. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 2429. doi:10.1158/1538-7445.AM2013-2429

Obturator hernia: the relationship between anatomical classification and the Howship-Romberg sign

BACKGROUND

The obturator hernia sac may follow the anterior or posterior branch of the obturator nerve, and thus, it can be classified anatomically. The relationship between the symptoms and the anatomical classification of obturator hernia has not yet been clearly described in the literature.

METHODS

Multidetector-row computed tomography (MDCT) examinations of 35 consecutive cases of new-onset obturator hernia admitted from March 2005 to April 2012 were reviewed retrospectively. Obturator hernia was classified anatomically using MDCT. Patient characteristics and clinical presentations were compared among the anatomical classifications.

RESULTS

Fifteen cases were classified as type I (anterior branch type) and 20 cases as type II (posterior branch type). There were no significant differences regarding time from onset of symptoms to diagnosis, presence of small bowel obstruction, and need for bowel resection. The Howship-Romberg sign was seen in 6 cases (30 %) of type II and 10 cases (67 %) of type I (p = 0.044).

CONCLUSIONS

The Howship-Romberg sign was present significantly more often with the anterior than the posterior branch type of obturator hernia.

Development of a new aortoscope system for the use of endovascular intervention

"Balloon aortoscopy" is a technique for viewing inner wall of aorta and used in clinics. By this method, endoluminal aortic surface could be clearly monitored, however, during this period, the aortic blood flow is blocked off by the inflated balloon. To solve this clinical problem, we have been developing a prototype aortoscope system without blocking off aortic flow aiming for the use of an assistive technique for endovascular interventions such as stent-graft placement for aortic aneurysm and have been evaluating through in vitro and in vivo tests. The technique introduced for this purpose was the use of intermittent and instantaneous saline jet controlled by a high-speed electromagnetic valve synchronized to heart beat (diastolic phase). In the previous study, we designed an endoscope with two channels (one for saline discharge and the other for forceps insertion), and confirmed the validity of this method by in vitro and in vivo tests. Based on these findings, in this study, we have newly designed a conventional and low price endoscope system aiming for wide clinical use. From the results of in vitro tests using a mock circulation system, it was confirmed that the newly designed system was capable of visualizing a target installed on an inner surface of the mock system suggesting an availability of the system for an aortoscope without blocking off aortic flow.

MicroRNA miR-34b/c enhances cellular radiosensitivity of malignant pleural mesothelioma cells

BACKGROUND

We previously reported that epigenetic silencing of microRNA-34b/c (miR-34b/c) plays an important role in the pathogenesis of malignant pleural mesothelioma (MPM). We examined the impact of miR-34b/c restoration on the radiosensitivity of MPM cells.

MATERIALS AND METHODS

We established stable miR-34b/c and scramble transfectants of two MPM cell lines, H2052 and H28. We examined these transfectants by clonogenic survival assay, phosphorylated histone H2AX (γH2AX) foci assay, cell-cycle analysis, and western blotting.

RESULTS

The clonogenic survival assay revealed that miR-34b/c radiosensitized MPM cells. γH2AX foci assay showed that DNA double-strand break repair was delayed in miR-34b/c transfectants. The proportion of sub-G(1) phase cells was increased in miR-34b/c transfectants after irradiation. miR-34b/c inhibited expression of cyclin-D1, cyclin-dependent kinase 4/6, B-cell lymphoma-2 (BCL-2) and increased cleaved poly (ADP-ribose) polymerase (cPARP) and cleaved caspase-3 after irradiation.

CONCLUSION

Our results indicate that miR-34b/c enhances radiosensitivity by promoting radiation-induced apoptosis and suggested that miR-34b/c might be a useful therapeutic molecule to enhance radiotherapy in MPM.

Impact of GLUT1 and Ki-67 expression on early‑stage lung adenocarcinoma diagnosed according to a new international multidisciplinary classification

High expression levels of glucose transporter isoform 1 (GLUT1) and Ki-67 are reportedly associated with malignancy-related clinicopathological factors in malignant tumors. Recently, a new histological IASLC/ATS/ERS classification for lung adenocarcinoma was proposed. In this study, we investigated the clinicopathological impact of GLUT1 and Ki-67 expression on early-stage lung adenocarcinoma classified according to the IASLC/ATS/ERS classification. One hundred and five patients with completely resected stage IA lung adenocarcinoma were retrospectively classified into two groups, a 'non-invasive type' (n=31) or an 'invasive type' (n=74), based on the IASLC/ATS/ERS classification. GLUT1 and Ki-67 expression status was evaluated using immunohistochemistry. The epidermal growth factor receptor (EGFR) and KRAS mutation status was determined using PCR-based assays. Positive GLUT1 and Ki-67 expression and EGFR and KRAS mutations were detected in 28 (27%), 33 (31%), 51 (49%) and 5 (8%) cases, respectively. Positive GLUT1 expression was significantly associated with a wild-type EGFR and mutant KRAS status. A multivariate analysis revealed that positive GLUT1 expression was independently associated with the 'invasive type'. In multivariate analyses for overall survival (OS) and disease-free survival (DFS), positive Ki-67 and GLUT1 expression was the only independent factor for a poor OS (P=0.012) and DFS (P=0.040), respectively. In addition, when stratified according to the GLUT1 and Ki-67 status, double-positive cases had the poorest DFS and OS times, compared with the other categories. Positive GLUT1 expression is associated with the invasive character of early-stage lung adenocarcinoma and with early disease relapse. Our results strongly suggest that GLUT1 and Ki-67 play important roles in acquiring biological malignant potential in early-stage lung adenocarcinoma.

Transformation of ras transfected BALB 3T3 clone (Bhas 42) by promoters: Application for screening and specificity of promoters

BALB 3T3 cells transfected by v-Ha-ras (Bhas 42 clone) were found to be sensitive to contact inhibition, but were susceptible to drastic transformation by 12-O-tetradecanoylphorbol-13-acetate. These results indicate that Bhas 42 cells are the initiated cells in the two-stage transformation process. By plating Bhas 42 cells together with BALB 3T3 cells followed by treatment with known promoters, a transformation assay system was established for the detection of tumour promoters. The Bhas 42 system showed advantages over conventional chemically induced transformation assays at several points, but some promoters did not induce transformation of Bhas 42 cells.

Colonoscopic enema as rescue for inadequate bowel preparation before colonoscopy: a prospective, observational study

AIM

Colonoscopy may need to be rescheduled because of inadequate bowel preparation. We evaluated the effectiveness of colonoscopic enema as rescue for an inadequate 1-day bowel preparation before colonoscopy.

METHOD

Patients referred for afternoon colonoscopy were prospectively enrolled in the study during a 1-year period. Patients took bowel preparation (polyethylene glycol) solution on the morning of the endoscopy. If during colonoscopy the bowel preparation was poor, an enema of polyethylene glycol solution (500 ml) was instilled into the colon at the level of the hepatic flexure via the biopsy channel of the colonoscope which was then removed. The patient was allowed to recover from the propofol sedation and used the bathroom to evacuate the enema. The colonoscope was then introduced and the examination continued.

RESULTS

Of 504 patients undergoing colonoscopy, 26 (4.9%) received an enema. The median age was 59 (29-79) years and 19 (73%) were female. A subsequent successful colonoscopy was achieved in 25/26 (96%). There were no complications. The mean time spent for the entire colonoscopy from the initial preparation to the end of the examination including the enema was 7.6± 1.1h (5.4 h preparation, 0.2h first colonoscopy+enema, 0.66h waiting in the lavatory, 0.33h second colonoscopy and 1 h for recovery).

CONCLUSION

Colonoscopic enema was highly successful as rescue for patients with inadequate bowel preparation and avoided postponement of the procedure.

A fatal case due to cough syrup abuse

We describe here a fatal abused case of cough syrup, containing chlorpheniramine and dihydrocodeine. Postmortem blood concentration of chlorpheniramine was above fatal levels, but dihydrocodeine concentration was within a therapeutic ranges, and those drug levels in blood were discussed from the viewpoint of forensic pharmacokinetics. We concluded that the cause death was due to the chlorpheniramine poisoning.

KEYWORDS

cough syrup abuse - chlorpheniramine - dihydrocodeine.

Impact of aberrant methylation of microRNA-9 family members on non-small cell lung cancers

MicroRNAs (miRs) contribute to cancer development and progression by acting as oncogenes and tumor suppressor genes. miR-9 family members (miR-9s), including miR-9-1, 9-2 and 9-3, have been shown to be oncogenically involved through the downregulation of E-cadherin expression, which promotes the epithelial-mesenchymal transition. Tumor suppressive roles of miR-9s have also been reported to silence miR-9 through methylation, which is associated with an shortened overall survival (OS) period in several types of cancer. In this study, the impact of miR-9s methylation on non-small cell lung cancers (NSCLC) was investigated. In total, 293 resected NSCLC samples were examined and the miR-9s methylation status was determined using a combined bisulfite restriction analysis. miR-9 expression was analyzed by in situ hybridization. Methylation of miR-9-1, 9-2 and 9-3 was present in 20 (7%), 33 (11%) and 34 (12%) of the cases, respectively. Methylation of any miR-9s (miR-9s methylation) was observed in 76 of the cases (26%), and miR-9 expression was silenced in cases with miR-9s methylation. Logistic regression analysis demonstrated that male gender [odds ratio (OR), 2.0; 95% confidence interval (95% CI), 1.1-3.6; P=0.01] and pathologically negative lymph node metastasis (OR, 4.8; 95% CI, 1.4-17.2; P=0.002) were independent relative factors for miR-9s methylation. Additionally, miR-9s methylation [hazard ratio (HR), 4.2; 95% CI, 1.2-27.0; P=0.026] and early pathological stage (HR, 8.3; 95% CI, 2.1-28.6; P=0.004) were found to be independent predictive factors for prolonged OS time by the Cox proportional hazard test. miR-9s methylation which induces expression silencing is common in NSCLC cases without lymph nodal metastasis, suggesting that miR-9s are oncogenically involved in NSCLC carcinogenesis through the promotion of tumor metastasis.

Invasive colorectal cancer within 5 years of negative colonoscopy in a Japanese population

AIM

Colonoscopy provides imperfect protection against colorectal cancer (CRC). In an attempt to improve cancer detection we evaluated the clinical features of invasive CRC detected within 5 years of a negative colonoscopy.

METHOD

The details of colonoscopies performed in a rural hospital in Japan were prospectively recorded at the time of the examination. The patients were followed over 5 years for the subsequent occurrence of cancer.

RESULTS

In a 5-year period, 10148 patients underwent colonoscopy and 202 without previous colonoscopy were diagnosed with invasive CRC. Of 3212 patients with a colonoscopy negative for cancer, nine developed invasive cancer within 5 years. The ratios for invasive CRC detected without/with previous colonoscopy were 60:1 in the rectum, 54:1 in the sigmoid colon, 15:1 in the descending colon, 28:0 in the transverse colon, 31:5 in the ascending colon and 14:1 in the caecum (P=0.041). The ratio between left- and right-sided colonic cancer was also significantly different (129:3 and 45:6, P=0.0078). Six (67%) of the invasive CRCs were in the ascending colon or caecum. Five of six patients with invasive CRC in the ascending colon and caecum had right-sided small adenomas at prior colonoscopy.

CONCLUSION

The majority of early/missed CRCs were right-sided and associated with prior right-sided colonic adenomas. Repeated colonoscopy of patients with right-sided adenomas at a shorter surveillance interval deserves consideration.

Language lateralization represented by spatiotemporal mapping of magnetoencephalography

BACKGROUND AND PURPOSE

Determination of hemispheric language dominance is critical for planning epilepsy surgery. We assess the usefulness of spatiotemporal source analysis of magnetoencephalography for determining language laterality.

MATERIALS AND METHODS

Thirty-five patients with epilepsy were studied. The patients performed a semantic word-processing task during MEG recording. Epochs containing language-related neuromagnetic activity were averaged after preprocessing. The averaged data between 250 and 550 ms after stimulus were analyzed by using dynamic statistical parametric mapping. ROIs were obtained in the opercular and triangular parts of the inferior frontal gyrus, superior temporal gyrus, and supramarginal gyrus in both hemispheres. We calculated laterality indices according to 1) dSPM-amplitude method, based on the amplitude of activation in the ROIs, and 2) dSPM-counting method, based on the number of unit dipoles with activation over a threshold in the ROIs. The threshold was determined as half of the maximum value in all ROIs for each patient. A LI ≥0.10 or ≤-0.10 was considered left- or right-hemisphere dominance, respectively; a LI between -0.10 and 0.10 was considered bilateral. All patients underwent an intracarotid amobarbital procedure as part of presurgical evaluation.

RESULTS

The dSPM-counting method demonstrated laterality consistent with the IAP in 32 of 35 patients (91.4%), the remaining 3 (8.6%) demonstrated bilateral language representation, whereas the dSPM-amplitude method showed 18 (51.4%) concordant and 17 (48.6%) bilateral. No laterality opposite to the IAP was found.

CONCLUSIONS

Spatiotemporal mapping of language lateralization with the dSPM-counting method may reduce the necessity for an IAP in as many as 90% of patients.

N = 16 spherical shell closure in 24O

The unbound excited states of the neutron drip-line isotope 24O have been investigated via the 24O(p,p')23O + n reaction in inverse kinematics at a beam energy of 62  MeV/nucleon. The decay energy spectrum of 24O* was reconstructed from the momenta of 23O and the neutron. The spin parity of the first excited state, observed at E(x) = 4.65±0.14  MeV, was determined to be J(π) = 2+ from the angular distribution of the cross section. Higher-lying states were also observed. The quadrupole transition parameter β2 of the 2(1)+ state was deduced, for the first time, to be 0.15±0.04. The relatively high excitation energy and small β2 value are indicative of the N = 16 shell closure in 24O.

Endoscopic decompression of benign large bowel obstruction using a transanal drainage tube

AIM

Endoscopic decompression of malignant colorectal obstruction is often dealt with using expandable metallic stents. Endoscopic decompression of benign large bowel obstruction is more difficult. We report the technique and outcome of transanal endoscopic decompression for benign large bowel obstruction.

METHOD

From January 2001 to June 2010, endoscopic decompression using a transanal drainage tube placement was attempted in consecutive patients with benign large bowel obstruction. The clinical features, technical success, complications, treatment after the tube placement and clinical success were retrospectively evaluated.

RESULTS

There were 13 patients (seven males, age 47-87, mean 69 years). The sites of obstruction were transverse colon [5 (38%)], sigmoid colon [3 (23%)], ileocecal valve [2 (15%)], splenic flexure [1 (8%)], descending colon [1 (8%)] and rectum [1 (8%)]. The most common cause of obstruction was anastomotic stricture [9 (69%)]. In 12 (92%) patients transanal decompression was technically successful with one perforation. An overtube, the reinsertion of colonoscope along the decompression tube, or the use of a small-diameter endoscope was required for the tube placement in seven (54%). In seven (54%) patients tube placement alone resulted in relief of bowel obstruction without operation.

CONCLUSION

Endoscopic decompression using a transanal drainage tube is effective for the management of benign large bowel obstruction.

Abstract 3988: Aberrant NFKBIA expression in lung adenocarcinomas arising from never smokers

[Background] Lung cancer in never-smoker (NS) is known as a seventh cause of cancer-related death. Activating mutation of epidermal growth factor receptor (EGFR) gene is frequently observed in non-small-cell lung cancers (NSCLCs) with never smoking history and it is significantly associated with the sensitivity of EGFR tyrosine kinase inhibitor (EGFR-TKI). Recently, NFKBIA gene, a tumor suppressor gene, has been reported to be silenced by deletion in glioblastomas, and in NSCLCs, its expression level is associated with clinical outcome of EGFR-TKI therapy. In this study, we examined NFKBIA expression and the genetic alterations of EGFR, K-ras, EML4-ALK to investigate the inter-relationship between these genetic alterations and clinicopathological factors among lung adenocarcinomas in NS. [Material and Method] We obtained ninety seven lung adenocarcinomas samples in NS which were resected at our institution. Four NSCLC cell lines (NCI-H1299, NCI-H1650, HCC827, NCI-H1819) were also investigated. We examined NFKBIA expression using immunohistochemistory (IHC) in tumor samples and real time reverse transcriptional PCR (RT-PCR) in cell lines, respectively. Mutational statuses of EGFR and K-ras genes were determined using mutant-enriched PCR assay and direct sequencing, respectively. EML4-ALK fusion was screened by ALK IHC and confirmed using RT-PCR assay. The methylation status of NFKBIA gene is investigated by methylation specific PCR assay and bisulfite sequencing. [Result] NFKBIA expression was silenced in 36 out of 97 samples (37.1%). EGFR mutation, K-ras mutation, and EML4-ALK fusion were detected in 61.8%, 2.1%, and 1.0% of 97 samples, respectively. Of note, the silencing of NFKBIA expression was significantly frequent in EGFR wild-type patients than in EGFR mutant patients (p=0.0024), while there was no correlation between NFKBIA expression level and K-ras mutation or EML4-ALK fusion. Although NFKBIA expression was silenced in NCI-H1299 and NCI-H1650, NFKBIA expression was not restored after 5-Aza treatment in these cell lines. In addition, NFKBIA methylation was found in these two cell lines. [Conclusion] Our findings suggest that the degradation of NFKBIA expression is a frequent event in lung adenocarcinomas of NS and may mediate an important non-tobacco carcinogenic pathway especially among lung adenocarcinoma with wild-type EGFR.

Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 3988. doi:1538-7445.AM2012-3988

Abstract 1717: Prognostic impact of cancer stem cell-related markers in non-small cell lung cancer patients treated with induction chemoradiotherapy

Background: Several cancer stem cell (CSC) related markers have been confirmed to be expressed in non-small cell lung cancer (NSCLC). The aim of this study was to clarify the prognostic role of CSC related markers expression in locally advanced NSCLC with induction chemoradiotherap (CRT).Methods: Fifty patients with clinically N2 or N3 NSCLC underwent induction CRT with cisplatin and docetaxel concurrently with thoracic radiation followed by surgery. Expressions of CSC related markers (CD133, ABCG2, ALDH1, and Bmi-1) were examined by immunohistochemical stain from surgical resected specimen. The prognostic factors were investigated by multivariate analysis using Cox proportional hazard model.Results: Among 50 patients, 20 patients had no pathologically residual tumor cell in the surgical resected specimen, and CSC related markers expressions were evaluated in other 30 patients. With a median follow-up duration of 71 months, the 5-year overall survival rate in the patients of CD133 or ALDH1 -positive was significantly worse than that in the patients of CD133 and ALDH1 -negative (90.0% vs. 44.9%, respectively, P = 0.042). In multivariate analysis, CD133 and ALDH1 negativity (Hazard ratio [HR] 0.16, 95% confidential interval [CI]: 0.0086-0.98, P = 0.047) and c-N2-3 single node metastasis (not multi node metastasis) (HR 0.19, 95% CI: 0.028-0.91, P = 0.03) were significant independent prognostic factors for the prolongation of survival.Discussion: The expressions of CSC related markers after CRT are significantly related to poor prognosis in NSCLC. The development of therapeutic strategy including adjuvant therapy, is a key for further improvement of prognosis in patients who underwent trimodality therapy.

Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 1717. doi:1538-7445.AM2012-1717

Abstract 4551: Prognostic impact of GLUT-1 and Ki-67 expressions in early-stage lung adenocarcinomas

Background: Adenocarcinoma (AD) is the most common histology of non-small cell lung cancer (NSCLC). Five-year disease-free survival rates (5-DFS) remain 80% for stage IA lung AD at best, and it is clinically required to identify biomarkers that can predict clinical outcome in the patients with early stage ADs. The glucose transporter isoform 1 (GLUT-1), that is one of the glucose transporter (GLUT) family, is expressed in most types of cells with metabolic change caused by hypoxia. The Ki-67 protein is known as maker of proliferation. Overexpressions of GLUT-1 and Ki-67 are knouwn as prognostic marker in many types of cancers. We determined the expression levels of GLUT-1 and Ki-67 to evaluate the impact of these alterations on the clinical outcome in early stage lung AD. Materials and Methods: We reviewed 105 patients with stage IA lung AD who underwent complete resection at our institute between January 2004 and December 2006. Expressions of GLUT-1 and Ki-67 were evaluated by Immunohistochemistry. The GLUT-1 expression was considered positive if the percentage of tumor cells staining was more than 10%. The Ki-67 staining was evaluated by the labeling index, and was considered positive when the labeling index was more than 15%. The significance of the differences between two groups was determined using the chi-square test. The 5-DFS and 5-year overall survival (5-OS) were evaluated by Kaplan-Meier analysis. Results: GLUT-1 and Ki-67 expressions were positive in 12 (11.4%) and 33 (31.4%) out of 105 patients, respectively. High GLUT-1 expression is significantly frequent in male (P=0.005), ever-smoker (P=0.005), and tumors with more than 2 cm at maximum diameter (P=0.033), and high Ki-67 expression is significantly frequent in male (P&lt;0.001) ever-smoker (P=0.005), and tumors without predominance of lipidic component (new lung adenocarcinoma criteria: JTO 2011)(P=0.006). Positive expressions of GLUT-1 and Ki-67 were correlated with each other (P =0.002). The 5-OS and 5-DFS rates of all 105 patients were 94.6% and 90.2%, respectively. The 5-DFS rates in the GLUT-1 and Ki-67 positive patients were significantly poorer than that of GLUT-1 and Ki-67 negative patients, respectively (45.6% vs. 96.2% in GLUT-1; P &lt; 0.001) (71.7% vs. 98.3% in Ki-67; P &lt; 0.001). Male sex and smoking history were also significantly associated with the poor DFS. A multivariate analysis revealed that positive expressions of GLUT-1 (Hazard ratio [HR]: 0.14, P = 0.009) and Ki-67 (HR: 0.19, P = 0.046) independently associated with poor clinical outcome. Conclusion: High GLUT-1 and Ki-67 expressions are present in larger or lipidic non-predominant lung adenocaricinomas, respectively, and they can independently predict clinical outcome of patients with early stage lung adenocarcinomas.

Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 4551. doi:1538-7445.AM2012-4551

Abstract 7: Knockdown of EGFR to investigate its therapeutic potential for treatment of non-small cell lung cancers

Background: Epidermal growth factor receptor (EGFR) is a transmembrane protein consisting of an extracellular ligand-binding domain, and its activation leads to a multitude of effects including cell proliferation, cell differentiation, angiogenesis, metastasis, and antiapoptosis. EGFR can be a partner of heterodimer of other EGFR family such as HER2 and HER3. EGFR is often overexpressed in non-small cell lung cancer (NSCLC). Anti-EGFR agents including EGFR-tyrosine kinase inhibitors (EGFR-TKIs) have considered to be effective for NSCLC when drug sensitive EGFR mutation is present. However, inherent and acquired resistances are major problems of EGFR targeting therapies. In this study, we knock-downed EGFR using small interfering RNAs (siRNAs) in NSCLC cell lines to examine the significance of targeting EGFR for NSCLC therapy. Materials and methods: We treated 14 NSCLC cell lines including nine EGFR mutant and five EGFR wild-type cell lines by geftinib or siRNAs for EGFR knock-down (siR-EGFR). Three cell line, PC-9-GR-N1, RPC-9, and HCC827-Met, were experimentally established as acquired resistant cells to gefitinib. The anti-tumor effect was determined by MTS or colony formation assay. The protein expression was evaluated using Western blotting. Results: All cell lines showed the expression of EGFR protein and siR-EGFR treatment down-regulated EGFR protein in all 14 cell lines. siR-EGFR suppressed cell viability in 7 of 9 EGFR mutant cells ranged from 8.0% to 73%. PC-9-GR-N1 and RPC-9 also showed inhibition. NCI-H1670 and HCC827-Met harboured EGFR mutation but were not inhibited. Of note, PTEN was deleted in NCI-H1670 and c-MET was amplified in HCC827-Met. Cell viability of all EGFR wild-type cells was not inhibited except NCI-H411. Conclusion: Our results indicated that EGFR can be the therapeutic target of NSCLC with EGFR activation. By contrast, targeting EGFR is not appropriate strategy for tumor of which EGFR is not activated even though EGFR is expressed.

Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 7. doi:1538-7445.AM2012-7

Abstract 4153: Usefulness of sensitive digital PCR assay to quantify microRNA-34b/c methylation in the circulating serum DNA of malignant mesothelioma patients

. Background: Malignant mesothelioma (MM) is an aggressive tumor but it can sometimes be cured if its clinical stage is not advanced. It is very expected to establish a useful screening test for early detection of MM. Recently we have found that DNA methylation of microRNA-34bc (miR34b/c) plays a dismal role on pathogenesis of MM and is frequently observed in MM. Circulating DNA from malignant tumors is known to be found in the serum of the patient. Digital polymerase chain reaction (PCR) is a high sensitive quantitative assay using real time PCR assay. In order to establish a new early detection system for MM, we quantify the extent of DNA methylation of miR-34b/c using a digital PCR assay in the circulating serum DNA from MM. Material and methods: We collected serum samples from 30 MM patients, 22 patients with benign asbestos pleurisy (BAP), and 10 healthy volunteers (HV) at Okayama Rosai Hospital, NHO Yamaguchi Ube Medical Center and our institute during January 2006 to August 2009. The circulating serum DNA was extracted using QIAamp Circulating Nucleic Acid Kit (Qiagen) followed by bisulfite conversion using EpiTect Bisulfite Kits (Qiagen) according to manufactural protocols. The real time PCR assay of methylation-specific PCR (MSP) for miR-34b/c was performed using SYBR Green method. In addition, the digital PCR of real time MSP assay was explored for 40 wells per each sample with a suitable dilution to aim the increase of sensitivity of PCR reaction, and we quantified the extent of methylation in each sample by counting the number of positive well of PCR reaction per sample. As positive and negative controls, the supernatant cultured medium of NCI-H290 harboring heavy methylation of miR-34b/c and water blank was used, respectively. Results: By melting curve analysis, we distinguished the miR-34b/c methylated wells from unmethylated wells based on the temperatures of PCR products of them (78.2 degree on methylated samples vs. 76.2 degree on un-methylated samples). Using the criteria above, each 40 wells per sample was defined as positive or negative for miR-34b/c methylation. The miR-34b/c methylated samples were defined as having more than three positive wells by ROC curve analyses. Finally, we found that the number of positive wells was significantly higher in MMs than that in other groups, and the miR-34b/c methylated samples was observed in 87% of MM patients, 45% of the patients with BAP, and 10% of HV, respectively, indicating that the miR-34b/c methylation in MM patients were significantly frequent than that in others (P &lt;0.0001). Conclusion: The digital PCR assay can detect miR-34b/c methylation in the circulation serum DNA of MM patients to find that miR-34b/c methylation is more frequent in MM than in BAP, suggesting that it may become a useful high-sensitive screening test to distinguish MM patients from the patients with BAP.

Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 4153. doi:1538-7445.AM2012-4153

Abstract 187: Down-regulation of microRNA34 induces cell proliferation and invasion of human mesothelial cells

Purpose: In the recent half-decade, many studies have shown that microRNAs (miRNAs) can act as oncogenes or tumor suppressors and that the widespread alteration of miRNA expression patterns is highly relevant to various human malignancies. We previously reported that microRNA-34s (miR-34s) are methylated and down-regulated in malignant pleural mesothelioma and might play an important role in the carcinogenesis of mesothelioma. In this study, in contrast to our previous study, we down-regulated miR-34s in the human mesothelial cells to investigate cellular effect of miR-34s knockdown. Material and methods: Two human mesothelial cell lines, MeT-5A derived from human pleura and LP-9 derived from human peritoneum, and three human primary cultured mesothelial cells from pleura were used in this study. Antisense mimics of miR-34a, b, and c (Anti-miR miRNA InhibitorR, Ambion) were transfected to these cells and effect of proliferation and invasion was estimated. Control scramble transfected cells were used as control. The protein expression status was estimated using Western Blotting. Results: Antisense miR-34a, b, and c down-regulated each miR-34s in introduced human mesothelial cells. Cell proliferation significantly increased in each antisense of miR-34s transfected human mesothelial cells than in control for all examined cells (p &lt; 0.0001 for miR-34s with all cells). Invasion ability also increased in antisense transfected cells than in control for MeT-5A and LP-9 (P &lt; 0.0001 for 2 cell lines). Human primary cultured mesothelial cells did not obtain invasion ability in this experiment. Western blotting confirmed up-regulation of c-Met and p-c-Met protein. Conclusion: We confirmed that down-regulation of miR-34s up-regulated oncogenic phenotype of mesothelial cells. The present study together with our previous report strongly suggests miR-34s play an important role in early carcinogenic process of human mesothelial cells to malignant mesothelioma.

Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 187. doi:1538-7445.AM2012-187

Development of a swallowing frequency meter using a laryngeal microphone

Disuse atrophy of swallowing-related organs is suspected when decreased swallowing frequency is seen in the elderly. However, swallowing frequency has not been examined in elderly people during daily life. We developed a swallowing frequency meter containing a laryngeal microphone that does not restrict the subject's ability to perform daily activities. In this study, the utility of the meter was assessed. Experiment 1: The ability of the meter to detect swallowing was examined. The subject was instructed to swallow saliva or foods at a voluntarily pace. During these procedures, swallowing events were simultaneously recorded by the meter, self-enumeration and videofluorography. As a result, all of the swallowing events identified by the meter coincided with the swallowing events identified by self-enumeration and videofluorography. Experiment 2: Swallowing sounds display various patterns both between and within individuals. Therefore, we examined the concordance rate between the number of swallowing events counted by the meter and that counted by self-enumeration in 15 subjects over a longer period than in experiment 1. The concordance rates calculated by two examiners between the meter and self-enumeration were 96·8 ± 4·5% and 98·9 ± 3·3% at rest and 95·2 ± 4·5% and 96·1 ± 4·1% during meals, respectively. Our findings indicate that this meter is useful for measuring the frequency of swallowing during daily situations.

Prognostic impact of cancer stem cell-related markers in non-small cell lung cancer patients treated with induction chemoradiotherapy

The expression of several cancer stem cell (CSC)-related markers has been confirmed in non-small cell lung cancer (NSCLC). The aim of this study was to clarify the clinical role of CSC-related markers in patients with NSCLC undergoing induction chemoradiotherapy (CRT). Fifty patients with clinically diagnosed N2 or N3 NSCLC who underwent induction CRT with docetaxel and cisplatin concurrently with thoracic radiation followed by surgery were examined in this study. The expressions of CSC related markers (CD133, ALDH1, ABCG2, and Bmi-1) were examined using immunohistochemical staining in surgically resected specimens. Among the 50 patients, 20 patients had no residual tumor cells in the resected specimen when examined pathologically; CSC-related marker expressions and their correlation to survival were evaluated in the other 30 patients. After a median follow-up period of 72 months, the 5-year overall survival rate of the patients with CD133-positive or ALDH1-positive specimens was significantly worse than that of the patients with both CD133-negative and ALDH1-negative expressions (44.9% vs. 90.0%, respectively; P = 0.042). In a multivariate analysis, CD133 and ALDH1 negativity (P = 0.047) and cN2-3 single station metastasis (P = 0.03) were significant independent prognostic factors for prolonged survival. The expressions of CSC-related markers after CRT were significantly correlated with a poor prognosis in patients with NSCLC. The development of therapeutic strategies including adjuvant therapy that take CSC-related marker positivity into consideration is likely to be a key factor in further improvements of the prognosis of patients undergoing trimodality therapy.

Active bleeding in acute subarachnoid hemorrhage observed by multiphase dynamic-enhanced CT

BACKGROUND AND PURPOSE

Acute SAH is reportedly associated with rebleeding from aneurysms, and recent advances in imaging technology allow us to visualize active bleeding in SAH cases. This study aimed to retrospectively investigate the incidence and characteristics of active bleeding in patients with spontaneous SAH by using multiphase dynamic-enhanced CT.

MATERIALS AND METHODS

We retrospectively surveyed a series of patients with SAH who underwent CTP with 18-phase dynamic enhancement and confirmed the presence of extravasated contrast medium in the source image. We compared clinical features between 2 groups of patients with and without extravasation.

RESULTS

Active bleeding was observed with increasing enhancement in 25.5% (13/51) of patients. All patients with extravasation were in Claassen grade 3 or 4 and WFNS grades 3, 4, or 5. The other group without extravasation included patients in all grades. A significant difference was observed in Claassen grade, WFNS grade, and increase of hematomas in follow-up CT (P < .05, for each) between the 2 groups. All CTP results of patients with extravasation were obtained within 2 hours of the onset of symptoms of SAH (P < .05). There was no significant difference in mortality at 14 days between the 2 groups (P = .128).

CONCLUSIONS

A high incidence of active bleeding (25.5%) was detected by multiphase dynamic-enhanced CT in patients with acute SAH. These results indicate that an awareness of active bleeding in patients with SAH has the potential to affect the treatment strategy.

H- beam extraction from a cesium seeded field effect transistor based radio frequency negative hydrogen ion source

H(-) beam was successfully extracted from a cesium seeded ion source operated using a field effect transistor inverter power supply as a radio frequency (RF) wave source. High density hydrogen plasma more than 10(19) m(-3) was obtained using an external type antenna with RF frequency of lower than 0.5 MHz. The source was isolated by an isolation transformer and H(-) ion beam was extracted from a single aperture. Acceleration current and extraction current increased with the increase of extraction voltage. Addition of a small amount of cesium vapor into the source enhanced the currents.

Development of a He- and He0 beam source for alpha particle measurement in a burning plasma

Proof of principle experiments of neutral helium beam production for alpha particle diagnostics was carried out on a test stand. Negative helium ions were produced in the Li charge exchange cell, in which stable and long time operation was possible. He(-) beam was accelerated to 157 keV. Finally, He(0) beam was successfully produced after the flight in the drift-tube through the auto-electron-detachment process from He(-) to He(0). A neutral beam detector using a pyroelectric device was also developed to measure He(0) beam intensity. The metastable component in the neutral helium beam was found to be less than 2%.

Extraction of a strongly focusing He+ beam from three-stage concave electrodes for alpha particle measurement system in ITER

A strongly focusing He(+) ion beam source equipped with concave multi-aperture electrodes was developed for production of He(-) through a charge exchange cell. The beam was extracted at a voltage less than 20 kV from 301 apertures distributed in an area of 100 mm φ, and focused at 750 mm distance. The beam current and the beam size of 2 A and 20 mm in diameter, respectively, were achieved with an arc power less than 10 kW. The optimum perveance was obtained at 0.02 A∕kV(1.5) at the beam energy less than 20 keV which is suitable for the conversion to He(-) in an alkali vapor cell.

An alpha particle measurement system using an energetic neutral helium beam in ITER (invited)

An energetic helium neutral beam is involved in the beam neutralization measurement system of alpha particles confined in a DT fusion plasma. A full size strong-focusing He(+) ion source (2 A, the beam radius of 11.3 mm, the beam energy less than 20 keV). Present strong-focusing He(+) ion source shows an emittance diagram separated for each beamlet of multiple apertures without phase space mixing, despite the space charge of a beamlet is asymmetric and the beam flow is non-laminar. The emittance of beamlets in the peripheral region was larger than that of center. The heat load to the plasma electrode was studied to estimate the duty factor for the ITER application.

Laser measurement of H- ions in a field-effect-transistor based radio frequency ion source

Hydrogen negative ion density measurements are required to clarify the characteristics of negative ion production and ion source performance. Both of laser photodetachment and cavity ring down (CRD) measurements have been implemented to a field-effect-transistor based radio-frequency ion source. The density ratio of negative hydrogen ions to electrons was successfully measured by laser photodetachment and effect of magnetic filter field on negative ion density was confirmed. The calculated CRD signal showed that CRD mirrors with >99.990% reflectivity are required and loss of reflectivity due to cesium contamination should be minimized.

Prognonstic impact of renin-angiotensin system blockade in localised upper-tract urothelial carcinoma

Background:

The potential role of the renin-angiotensin system (RAS) in the promotion of tumour growth has been investigated, and the administration of RAS inhibitors, such as angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin II receptor blockers (ARBs), may improve disease control in malignancy. We investigated the prognostic impact of RAS inhibitors by analysing data from patients with upper-tract urothelial carcinoma (UTUC).

Methods:

A total of 279 patients who underwent nephroureterectomy for localised UTUC (pTa-3N0M0) were identified at our three institutions. We retrospectively investigated the prognostic outcomes following nephroureterectomy in patients administered or not administered ACEIs or ARBs.

Results:

The median follow-up period was 3.4 years. RAS inhibitors were administered to 48 patients (17.2%). Multivariate analysis showed that the appearance of pathological T3, positive lymphovascular invasion, and no RAS inhibitor administration (P=0.027 HR=3.14) were independent risk factors for a decrease in subsequent metastasis-free survival. The 5-year metastasis-free survival rate was 93.0% in patients who administered RAS inhibitors, and 72.8% in their counterparts who did not (P=0.008).

Conclusion:

The absence of RAS inhibitor administration was an independent risk factor for subsequent tumour metastasis in patients with localised UTUC. We propose RAS inhibitors may be a potent choice as an effective treatment following nephroureterectomy.

Frequent methylation and oncogenic role of microRNA-34b/c in small-cell lung cancer

Small-cell lung cancer (SCLC) is an aggressive tumor with a dismal prognosis among primary lung cancers. MicroRNAs (miRNAs) can act as oncogenes or tumor-suppressor genes in human malignancy. The miR-34 family is comprised of tumor-suppressive miRNAs, and its reduced expression by methylation has been reported in various cancers, including non-small cell lung cancer (NSCLC). In this study, we investigated the alteration and tumor-suppressive impact of miR-34s in SCLC. The methylation of miR-34a and miR-34b/c was observed in 4 (36%) and 7 (64%) of 11 SCLC cell lines, respectively. Among the 27 SCLC clinical specimens, miR-34a and miR-34b/c were methylated in 4 (15%) and 18 (67%), respectively. In contrast, 13 (28%) miR-34a methylated cases and 12 (26%) miR-34b/c methylated cases were found in 47 NSCLC primary tumors. The frequency of miR-34b/c methylation was significantly higher in SCLC than in NSCLC (p<0.001). The expressions of miR-34s were reduced in methylated cell lines and tumors and restored after 5-aza-2'-deoxycytidine treatment, indicating that methylation was responsible for the reduced expression of miR-34s. Because the frequency of methylation was higher in miR-34b/c, we focused on miR-34b/c for a functional analysis. We examined the effect of miR-34b/c introduction on cell proliferation, migration and invasion. The transfection of miR-34b/c to two SCLC cell lines (H1048 and SBC5) resulted in the significant inhibition of cell growth, migration, and invasion, compared with control transfectants. Our results indicate that the aberrant methylation of miR-34b/c plays an important role in the pathogenesis of SCLC, implying that miR-34b/c may be a useful therapeutic target for SCLC.

Aberrant methylation of p21 gene in lung cancer and malignant pleural mesothelioma

Suppression of p21 has been implicated in the genesis and progression of many human malignancies. DNA methylation is an important mechanism of gene silencing in human malignancies. In this study, we examined the expression status and aberrant methylaion of p21 in lung cancers and malignant pleural mesotheliomas (MPM). We used 12 small cell lung cancer (SCLC) cell lines, 13 non-small cell lung cancer (NSCLC) cell lines, 50 primary NSCLCs, 6 MPM cell lines and 10 primary MPMs. The expression and methylation of p21 was examined by reverse transcription-PCR (RT-PCR), Western blotting and methylation-specific PCR (MSP) assay. Loss of p21 protein expression was observed in 7 SCLC cell lines (58.3%), 5 NSCLC cell lines (38.5%) and 3 MPM cell lines (50%) while mRNA expression was lost in 2 SCLC cell lines (16.7%), 2 NSCLC cell lines (15.4%) and none of the MPM cell lines. Aberrant methylation of p21 was found in 8.3% of SCLC cell lines, 30.2% of NSCLCs and 6.3% of MPMs. Among primary NSCLCs, methylation in adenocarcinomas was significantly more frequent than in squamous cell carcinomas. Loss of p21 expression was frequently observed in lung cancers and MPMs and aberrant methylation was one of the mechanisms of suppression of p21, especially in NSCLCs.

Strong anti-tumor effect of NVP-AUY922, a novel Hsp90 inhibitor, on non-small cell lung cancer

The anti-tumor activity of a newly developed Hsp90 inhibitor, NVP-AUY922 (AUY922), against non-small cell lung cancer (NSCLC) was examined. Twenty-one NSCLC cell lines were used, the somatic alterations of which were characterized. Cell proliferation was analyzed using a modified MTS assay. Expression of the client proteins was assessed using Western blotting. The cell cycle was analyzed using flow cytometry. The IC50 value of AUY922 for the NSCLC cell lines ranged from 5.2 to 860 nM (median, 20.4 nM). Based on previous data, cells with an IC50 of less than 50 nM were classified as sensitive cells and 19 of the 21 NSCLC cell lines were judged to be sensitive. The IC50 of five malignant pleural mesothelioma (MPM) cell lines revealed that the MPM cells had a significantly higher IC50 value (median, 89.2 nM; range, 22.2-24,100 nM) than the NSCLC cells (p=0.015). There was significant depletion of both the total and phosphorylated client proteins--EGFR, MET, HER2 and AKT--at low drug concentrations (50-100 nM) in drug-sensitive cell lines. Cell-cycle analysis was performed for two sensitive cell lines, H1975 and H838. Following AUY922 treatment, an increase in the sub-G0-G1 cell population, as well as appearance of cleaved PARP expression, indicated the induction of apoptosis. In conclusion, AUY922 was effective against most NSCLC cell lines, independent of the type of known molecular alteration, and appears to be a promising new drug for the treatment of NSCLC.

Radiation Dose Measurement with Newly Developed Head Phantom for Interventional Neuroradiology

Although it is important to measure and record radiation dose to a patient's skin, no standardized measuring method is available to compare the performance of digital subtraction angiography (DSA) systems with those of other institutions. We developed a new bidirectional information exchange system using a web page and, E-mail. Measurements are obtained using an original head phantom with skin dose monitors. This system was sent to institutions ordering it from the web page. The data obtained with this system by each institution were evaluated and displayed anonymously on a graph on the web page for comparison. This method for measuring radiation dose allows the comparison of DSA systems under identical conditions. This system can alert the user that the radiation dose delivered using ordinary parameters differs from that of other institutions or DSA systems. To promote the use of this system, we developed a web page with information about radiation dose measuring and initiated an online lending operation. This head phantom and standardized measuring method allows the accurate comparison of skin radiation dose and DSA performance under the same conditions.

Multimodal imaging of spike propagation: a technical case report

We report an 11-year-old boy with intractable epilepsy, who had cortical dysplasia in the right superior frontal gyrus. Spatiotemporal source analysis of MEG and EEG spikes demonstrated a similar time course of spike propagation from the superior to inferior frontal gyri, as observed on intracranial EEG. The tractography reconstructed from DTI showed a fiber connection between these areas. Our multimodal approach demonstrates spike propagation and a white matter tract guiding the propagation.

Expression patterns of several floral genes during flower initiation in the apical buds of apple (Malus × domestica Borkh.) revealed by in situ hybridization

The apple (Malus × domestica Borkh.) is one of the commercially important fruit crops in the worldwide. The apple has a relatively long juvenile period (up to 4 years) and a long reproductive period between the flower initiation and the mature fruit (14-16 months), which prevent the fruit breeding. Therefore, the understanding of the flowering system is important to improve breeding efficiency in the apple. In this study, to examine the temporal and spatial expression patterns of the floral genes, MdTFL1, MdAP1 (MdMASD5), AFL2, and MdFT, we conducted in situ hybridization analysis in the apple shoot apex. In vegetative phase, MdTFL1 was expressed on the rib meristem zone. When vegetative meristem began converting into inflorescence meristem, the expression level of MdTFL1 was drastically decreased. At the early stage of inflorescence meristem, the expression levels of AFL2, MdFT, and MdAP1 were up-regulated in the leaf primordia and the upper region of cell layers on the shoot apex. In late stage, the expression levels of AFL2 and MdAP1 were up-regulated in the young floral primordia. At a more advanced stage, high expression of MdAP1 was observed in the inflorescence primordium through the inner layer of sepal primordia and the outer layer of receptacle primordia and floral axis. Our results suggest that AFL2, MdFT, and MdAP1 affect to convert from the vegetative meristem into the inflorescence meristem after the decline of MdTFL1 expression. After that, AFL2 and MdAP1 promote the formation of the floral primordia and floral organs.