A case of pelvic squamous cell carcinoma of unknown primary origin that responded well to radiotherapy and nivolumab

Squamous cell carcinoma of unknown primary origin in the pelvis is rare. We report a case of a 64-year-old woman with a large osteolytic squamous cell carcinoma of unknown primary origin in the pelvis that presented with p16 expression. The patient presented with leg pain and swelling and was admitted to our hospital. Computed tomography scans of the pelvis revealed a large osteolytic tumor. A computed tomography-guided needle biopsy was performed, and pathological examination revealed neoplastic cells with metastatic squamous cell carcinoma presenting with p16 expression. Despite a whole-body examination, tumor origin remained undetected. The patient was treated for this metastatic squamous cell carcinoma of unknown primary using palliative radiotherapy for hip pain and nivolumab. Remarkable reduction in the tumor marker levels and tumor size were obtained after therapy. Finally, partial remission and progression-free survival for more than 7 months were achieved. In conclusion, we experienced a rare case with a large p16-positive squamous cell carcinoma of unknown primary in pelvis, which responded well to radiotherapy and nivolumab.

SMARCA4-deficient tumors in the adrenal gland and small intestines: A rare case report

Thoracic SMARCA4-deficient undifferentiated tumors (SMARCA4-UTs) are rare undifferentiated thoracic malignancies with poor prognosis. They predominantly affect young men who are heavy smokers. Recently, the category of SMARCA4-deficiency-related malignancy has been expanded to include extra-thoracic sites, such as the paranasal sinuses, gastrointestinal tract, ovary, and uterus. We report a rare case of SMARCA4-deficient tumors in the adrenal gland and small intestines. SMARCA4-deficient tumors should be included in the differential diagnosis when multiple large masses with heterogeneous contrast effect and strong accumulation are seen in cancers of unknown primary on 18F-fluorodeoxyglucose (FDG) positron emission tomography with computed tomography (PET/CT).

Evaluation of Pancreatic β-cell Differentiation Efficiency of Human iPSC Lines for Clinical Use

BACKGROUND

Transplantation of pancreatic β-cells generated from human induced pluripotent stem cells (hiPSCs) has great potential as a root treatment for type 1 diabetes. However, their current level of efficiency to differentiate into β-cells is still not at par for clinical use. Previous research has shown that differentiation efficiency varies among human embryonic stem cells and mouse-induced pluripotent stem cell lines. Therefore, selecting a suitable cell line for efficient induction into desired tissues and organs is crucial.

METHOD

In this study, we have evaluated the efficiency of 15 hiPSC lines available for clinical use to differentiate into pancreatic β-cells.

RESULTS

Our investigation has revealed induction efficiency to differ among the hiPSC lines, even when derived from the same donor. Among the hiPSC lines tested, the 16A01 cell line exhibited the highest insulin expression and low glucagon expression, suggesting that this cell line is suitable for differentiation into β-cells.

CONCLUSION

Our study has demonstrated the importance of selecting a suitable hiPSC line for effective differentiation into β-cells.

SAPHO syndrome with a purely osteolytic form: A case report

SAPHO (synovitis, acne, pustulosis, hyperostosis, and osteitis) syndrome is a rare, chronic autoinflammatory disorder that can present with a constellation of cutaneous and osteoarticular symptoms. Osteodestructive lesions are not pathognomonic, whereas hyperostosis and osteitis are the most prominent imaging findings. We report the case of a man with osteolytic changes of the lumbar vertebra and a history of palmoplantar pustulosis. Biopsy revealed no neoplasm, suggesting SAPHO syndrome. Our case demonstrates that knowledge of atypical radiologic findings is necessary for the diagnosis of SAPHO syndrome.

Chemical inhibitors of cyclin-dependent kinase (CDKi) improve pancreatic endocrine differentiation of iPS cells

Islet transplantation, including pancreatic beta cells, has become an approved treatment for type I diabetes. To date, the number of donors limits the availability of treatment. Induction of pancreatic endocrine cells from pluripotent stem cells including iPSCs in vitro offers promise as a solution, but continues to face problems including high reagent costs and cumbersome differentiation procedures. In a previous study, we developed a low-cost, simplified differentiation method, but its efficiency for inducing pancreatic endocrine cells was not sufficient: induction of endocrine cells is non-uniform, resulting in colonies containing relatively high ratio of non-pancreatic-related cells. Here, we applied cyclin-dependent kinase inhibitors (CDKi) within a specific time window, which improved the efficiency of pancreatic endocrine cell induction. CDKi treatment reduced the prevalence of multi-layered regions and enhanced expression of the endocrine progenitor-related marker genes PDX1 and NGN3 resulting in enhanced production of both INSULIN and GLUCAGON. These findings support a step forward in the field of regenerative medicine of pancreatic endocrine cells.

Fluorodeoxyglucose positron emission tomography (FDG/PET) shows the effect of carbon-ion radiotherapy (CIRT); with pathologic confirmation

Response evaluation of carbon-ion radiotherapy poses a diagnostic challenge. Due to its functional aspects, fluorodeoxyglucose positron emission tomography (FDG/PET) has a role in the diagnosis of photon radiation therapy. In addition, several studies suggested that FDG/PET may be useful to select the optimal site for performing a diagnostic biopsy. Here, we report a 73-year-old female in which FDG/PET was effective in determining the recurrence of liposarcoma and the therapeutic effect. Based on the results of FDG/PET, we could make a pathologic definitive diagnosis and selectively performing carbon-ion radiotherapy for active tumors.

A simple method of hiPSCs differentiation into insulin-producing cells is improved with vitamin C and RepSox

Human induced pluripotent stem cells (hiPSCs) are considered a promising source of pancreatic β-cells for the treatment of diabetes. However, this approach is limited by issues such as low efficiency and high cost. Here, we have developed a new protocol to induce insulin-producing cells. To reduce costs, we decreased the number of reagents and replaced protein reagents with chemical compounds. In this method, we increased induction efficiency with ascorbic acid (vitamin C) and an ALK5 inhibitor, RepSox. In 2D culture, the majority of cells were immature β-cells with low glucose-stimulated insulin secretion. Transferring to 3D culture immediately after endocrine progenitor cell differentiation, however, improved glucose-stimulated insulin secretion. This simplified method will contribute to realizing transplantation therapy of β-cells using iPSCs.

Swine model of in-stent stenosis in the iliac artery evaluating the serial time course

The aim of this study was to propose a new animal model evaluating the serial time course of in-stent stenosis by repeated carotid artery catheterization in the same animal. 16 bare-metal stents were implanted in the normal external and internal iliac artery of 8 miniature pigs. Repeated measurements were performed in the same animal every 2 weeks for 12 weeks through carotid artery catheterization. The time course and peak neointimal proliferation were evaluated by intravascular ultrasound. Health of all animals was assessed by clinical and hematological examinations. As a result, 7 times of carotid artery catheterization was performed per pig, but all animals remained healthy without both any complications and hematological inflammatory abnormalities. The time course of neointimal proliferation of each stent was observed from the stage of hyperplasia to partial regression. The peak neointimal proliferation varied from 6 to 12 weeks despite implantation of identical stents using the same deployment method. In conclusion, repeated carotid artery catheterization to the same animal is feasible without animal health deterioration. This model should be useful to evaluate the time course of neointimal proliferation after stent deployment in preclinical study.

Fam46a regulates BMP-dependent pre-placodal ectoderm differentiation in Xenopus

The pre-placodal ectoderm (PPE) is a specialized ectodermal region which gives rise to the sensory organs and other systems. The PPE is induced from the neural plate border during neurulation, but the molecular mechanism of PPE formation is not fully understood. In this study, we examined the role of a newly identified PPE gene, Fam46a, during embryogenesis. Fam46a contains a nucleoside triphosphate transferase domain, but its function in early development was previously unclear. We show that Fam46a is expressed in the PPE in Xenopus embryos, and Fam46a knockdown induces abnormalities in the eye formation and the body color. At the neurula stage, Fam46a upregulates the expression of PPE genes and inhibits neural crest formation. We also show that Fam46a physically interacts with Smad1/Smad4 and positively regulates BMP signaling. From these results, we conclude that Fam46a is required for PPE formation via the positive regulation of BMP signaling. Our study provides a new mechanism of ectodermal patterning via cell-autonomous regulation of BMP signaling in the PPE.

Prevalence of GORD (gastro-oesophageal reflux disease) in Type 2 diabetes and a comparison of clinical profiles between diabetic patients with and without GORD

AIMS

To examine the incidence of gastro-oesophageal reflux disease (GORD) and its associated factors in patients with Type 2 diabetes mellitus (Type 2 DM).

METHODS

In 859 Type 2 DM outpatients, we conducted a QUEST inquiry and considered those showing a QUEST score of 4 or higher as having GORD. We surveyed clinical variables (physical findings, gender, age, duration of disease, glycated haemoglobin (HbA(1c)), type of oral glucose-lowering agent, presence or absence of insulin therapy, complications, and presence or absence of agents that may be associated with GORD [Ca channel blocker (CCB) anti-platelet agents]) to investigate their association with the onset of GORD.

RESULTS

We analysed 813 subjects, of whom 56.6% were male. The mean age was 63.7 +/- 11.3 years and HbA(1c) 7.2 +/- 1.2%. The incidence of GORD was 29.0% (n = 221). GORD was positively correlated with body weight, body mass index (BMI) and HbA(1c). It was negatively correlated with age, serum creatinine and proportion of patients treated with pioglitazone or CCB. In addition, GORD was more common in females. The incidence of GORD was significantly higher in younger patients.

CONCLUSIONS

Previous studies have suggested a relationship of GORD with pioglitazone/CCB. However, the results of this study do not support this; these agents may not induce GORD.

Transarterial ethanol ablation for sporadic and non-hemorrhaging angiomyolipoma in the kidney

PURPOSE

We evaluated the efficacy and side effects of transarterial ethanol ablation in sporadic and non-hemorrhaging angiomyolipomas (AMLs) in the kidney.

MATERIAL AND METHODS

A total of 10 patients with solitary and sporadic AMLs underwent selective transarterial absolute ethanol ablation for prophylaxis against hemorrhage. We confirmed the ratio areas of tumor vessel on angiogram, those of infraction on post-ablation computed tomography (CT) and those of tumor reduction in a 3-, 6- and 12-month follow-up CT.

RESULTS

Once or twice a single infusion of 1 or 2 ml absolute ethanol achieved in a total occlusion of 22 feeding arteries which consisted of 7 proximal interlobar arteries, 12 distal interlobar arteries and 3 renal capsular arteries. Nontarget occlusion did not occur by ethanol reflux in any cases but occurred causing spasms provoked by repeated inflation and deflation of the balloon in one case. Total occlusion of tumor vessels was observed in 7 patients and 92-95% occlusion in 3. Ethanol ablation produced 1.8-22.5% (mean 8.4+/-6.8%) areas of infarctions but the outcome was not serious in all cases. Mean percentage areas of tumor reduction were 29.4+/-10.6% in a 3-month follow-up, 45.7+/-11.9% in a 6-month and 59.3+/-11.5% in a 12-month follow-up.

CONCLUSIONS

Absolute ethanol ablation for sporadic and non-hemorrhaging AML is safe and effective in reducing majority of tumor area in a 1-year follow-up.

Hemispatial visual-searching impairment correlated with decreased contralateral parietal blood flow in Alzheimer disease

BACKGROUND

Impairment of visuospatial attention in Alzheimer disease (AD) has not been fully investigated. Mendez et al reported that patients with AD showed hemispatial biases on visual search tasks. Parietal lobe involvement might be related to such impairment. The Picture Description Task is one of the most sensitive tests for detecting language disorders and might be also useful in assessing visual search.

OBJECTIVE

The applicability of the Picture Description Task for evaluating hemispatial visual search impairment of AD was investigated, as well as whether the hemispheric difference in parietal blood flow is related to such impairment.

METHODS

Thirty-four patients with AD and age-matched 16 normal subjects performed the Picture Description Task. The elements of the picture were divided into three portions: the right portions (five elements), the central portions (two elements), and the left portions (five elements), so as to assess the patients' hemispatial visual searching ability. Using single photon emission CT, the absolute regional cerebral blood flow (CBF) values at resting condition were calculated by the method of Kuhl et al.

RESULTS

Fourteen patients with AD showed a decreased number of elements pointed out in the left portion of the picture, whereas 12 patients had decreased attention in the right portion. The remaining eight pointed only to the central portion. None of them showed hemispatial neglect on the figure copying tasks. The patients with decreased left spatial attention had lower CBF in the right parietal lobe, and vice versa. A significant negative (biologically meaningful) Spearman correlation was found between the right-left indices of the elements pointed out in the picture and the CBF values.

CONCLUSIONS

The results suggest that the Picture Description Task is useful for assessing visual search, and impaired hemispatial visual search in AD is related to decreased contralateral parietal blood flow. The right-left asymmetry of the parietal CBF might be associated with hemispatial visual attention impairments in AD.

Morphological changes in osteoblastic cells (MC3T3-E1) due to fluid shear stress: cellular damage by prolonged application of fluid shear stress

We investigated the effect of fluid shear stress on both changes in morphology and in resting level of cytosolic concentrations of Ca2+ ([Ca2+]i) in MC3T3-E1 cells, osteoblast-like cells derived from the neonatal mouse calvaria. The cells were subjected to fluid shear stress at about 1.0 Pa. Morphological characteristics were compared between stressed and control cells by scanning electron microscopic examination, actin filament evaluation using phalloidin fluorescence and [Ca2+]i measurement using fura-2/AM. The stressed cells changed from a polygonal to a spindle shape after 1-hour exposure to fluid shear stress, whereas control cells remained polygonal, and the stressed cells exhibited an increase in the number of microvilli. The diameter in the long axis of the stressed cells was significantly larger than that of controls, and about half of the stressed cells were oriented nearly along the direction of the fluid shear stress. The arrangement of the actin filaments of the stressed cells changed to parallel, and was positioned along the long axis of the cell process. The resting level of [Ca2+]i in the stressed cells showed a peak at 1 hour after the application of the stress. A more prolonged stress period over 1 hour caused cell shrinkage, an irregularity on the cell surface, and a gradual decrease in the resting level of [Ca2+]i, suggesting that prolonged stress time may cause cellular damage.

A patient with improvement in short-term memory disturbance brought about by radiation therapy for germinoma involving Papez circuit

A 27-year-old male presented with memory loss. With magnetic resonance imaging (MRI), enhanced masses on the right side of hypothalamus, right side of anterior basal ganglia, and left side of hypothalamus were found. Histological analysis of the tumor by stereotactic biopsy proved it to be a germinoma. When related to the map of the thalamic nuclei, the tumor involved anterior column of the fornix and anterior nuclei of the thalamus. Neuropsychological tests prior to radiation therapy disclosed only short-term memory disturbance. The patient received radiation therapy to a total dose of 55 Gy to the primary lesion. After the completion of radiation therapy, the enhanced effect disappeared on gadolinium enhanced T1-weighted MRI. Single photon emission computed tomography indicated improvement in blood flow in the anterior portion of the bilateral thalami. Neuropsychological tests after radiation therapy showed improvement in short-term memory compared with baseline. Test results have remained stable for two and half years. This case indicates the possibility of improvement in memory function by treatment for tumor when it involves part of Papez circuit. Nevertheless, a decrease in intellectual ability by irradiation remains the major problem. Better approaches not only for cure but also to reduce the late effects should be undertaken when radiation therapy is the treatment of choice.

Postural and gait disturbance correlated with decreased frontal cerebral blood flow in Alzheimer disease

In a group of 45 patients with Alzheimer disease (AD) and 15 control subjects, we studied the relationship between parameters showing postural and gait disturbance and regional cerebral blood flow (rCBF) measured with N-isopropyl-p-[123I]iodoam-phetamine single photon emission computed tomography at different clinical stages. Patients with AD with mild dementia exhibited only increased postural sway associated with a reduced mean value of rCBF in the cortex. At a moderate stage, the reduced mean values of rCBF in the cortex and in the frontal lobe were associated with increased postural sway and stride length variability and with decreased stride length. At a severe stage, reduced rCBF in the basal ganglia and in the frontal lobe additionally were associated with increased postural sway, double support time, and stride length variability, and with decreased walking speed and stride length. In multiple regression analysis, there was a high contribution by rCBF in the frontal lobe to account for postural and gait disturbance in AD. We propose that impaired frontal lobe circulation is an important factor causing postural and gait disturbance as AD progresses.

[MR imaging of cerebral palsy]

We evaluated 35 patients with cerebral palsy on the basis of MR imaging findings in the brain. The types of palsy were spastic quadriplegia (n = 11), spastic diplegia (n = 9), spastic hemiplegia (n = 2), double hemiplegia (n = 1), athetosis (n = 10) and mixed (n = 2). Of all patients, 28 (80%) generated abnormal findings. In spastic quadriplegia, although eight cases revealed severe brain damage, two cases showed no abnormal findings in the brain. One of the three had cervical cord compression caused by atlanto-axial subluxation. In spastic diplegia, the findings were divided according to whether the patient was born at term or preterm. If the patient had been born prematurely, the findings showed periventricular leukomalacia and abnormally high intensity in the posterior limbs of the internal capsule on T2-weighted images. MR imaging in spastic hemiplegia revealed cerebral infarction. In the athetoid type, half of all cases showed either no abnormal findings or slight widening of the lateral ventricle. Three cases showed abnormal signals of the basal ganglia. The reason why athetoid-type palsy did not show severe abnormality is unknown. We believe that MR imaging is a useful diagnostic modality to detect damage in the brain in cerebral palsy and plays an important role in the differentiation of cerebral palsy from the spastic palsy disease.

[Clinical evaluation of cefmenoxime in internal medicine, with special reference to infections associated with hematological disorders]

Clinical evaluation of cefmenoxime (CMX, Bestcall) was examined in the infection associated with hematological disorders, respiratory tract and other disorders. Clinical effectiveness for severe infection of hematological disorders was 47.4% in good and 84.2% in fair response, however, in the respiratory tract infections, 89.7% in good response was obtained. Opportunistic infection due to Gram-negative bacilli are often experienced in patients with hematological disorders. It was discussed that CMX would be a good therapeutic agent against infectious diseases associated with hematological disorders because it's antibacterial spectrum would be parallel to pathogens of such disorders.

Interaction of triazolam with desipramine. Effects of single and repeated treatment on certain pharmacologic responses and brain catecholamine levels

The present study was undertaken to evaluate the effects of single and repeated doses of triazolam (1 mg/kg IP) and desipramine (DMI) (10 mg/kg IP) alone and in combination on certain pharmacologic responses and brain catecholamine levels in rats. The significant findings were: (1) triazolam and DMI given alone and in combination were synergistic with pentobarbital (PB) hypnosis; (2) repeated treatment with DMI alone repressed body weight gain; triazolam potentiated this anorectic effect; (3) triazolam induced muscle relaxation acutely, but was not affected by concomitant DMI treatment; and (4) triazolam and DMI given in combination produced hypothermia although the drugs given separately did not. Development of tolerance to hypothermia and to anorectic effects produced by triazolam and DMI significantly decreased norepinephrine (NE) levels in the hypothalamus as compared to the repeated treatment with triazolam, and significantly increased NE and dopamine (DA) levels in the striatum and DA levels in the cortex, as compared to the single treatments.

Simple method for the determination of choline and acetylcholine by prolysis gas chromatography

An improved purification procedure is described for the simultaneous assay of endogenous choline and acetylcholine by pyrolysis gas chromatography, particularly for providing a simple and effective method for propionylation of choline in the presence of acetylcholine. The reaction was carried out in acetonitrile solution prepared by dissolving the evaporated residue of the supernatant of brain homogenate. Thus samples for propionylation were prepared without the use of ion-exchange chromatography.

HLA and Japanese MS

Determination of HLA-A, -B and -C types in 43 Japanese patients with multiple sclerosis (MS) and of DR type in 25 MS patients was carried out using antisera from the 7th International Histocompatibility Workshop. The results were compared with 46 controls typed simultaneously. Twenty-three patients were also tested for HLA-Dw2. The conclusions were: 1) There were no significantly higher occurrences of HLA-A3, B7, Dw2 or DRw2 in Japanese MS. 2) Japanese MS might nevertheless be associated with the human major histocompatibility complex, because HLA-B40 was significantly less frequent in MS and two anti HLA-DRw sera, 7w008 and 034, reacted positively more often against lymphocytes from MS patients.

A new microwave device for rapid thermal fixation of the murine brain

A microwave applicator was developed to provide rapid thermal fixation of enzymes in the murine brain. Although the power output of the device is only 1.3 kW, whole-brain levels of acetyicholine after microwave fixation are comparable to those observed at a power output of 5 kW, and are markedly higher than those obtained by a conventional method (freezing) of fixation.