Temporal variability of 137Cs concentrations in coastal sediments off Fukushima

Large amounts of radiocesium were released into marine environments following the Fukushima Daiichi Nuclear Power Plant accident in March 2011. Released radiocesium influenced not only marine environment but also marine biota in Fukushima. Since marine biota as fisheries products is important for Japanese market, it is important to assess the distribution of radiocesium in coastal environment off Fukushima for safety concerns of radioactive contamination. Radiocesium concentrations in sediments are important for understanding fishing ground conditions and for proving the safety of fisheries products in Fukushima. In this study, monthly monitoring data collected from May 2011 to March 2020 were analyzed to describe the temporal variability of ¹³⁷Cs concentrations in coastal sediments off Fukushima (total of 3647 samples from eight lines at depths of 7-125 m off Fukushima, and three sites in Matsukawa-ura Lagoon). The ¹³⁷Cs concentration in sediment showed a decreasing trend, but our nonlinear model fitting suggested that this rate of decrease had slowed down. Additionally, ¹³⁷Cs concentrations were up to 4.08 times greater in shallow sampling sites (7, 10, 20 m depth) following heavy rainfall events (before five months vs. after five months), such as typhoons. These observations were consistent with increasing input from particulate ¹³⁷Cs fluxes from rivers and increasing dissolved ¹³⁷Cs concentrations in seawater. Finally, our numerical modeling suggested that riverine ¹³⁷Cs input could maintain ¹³⁷Cs concentrations in coastal sediment. These results indicate that riverine ¹³⁷Cs input following heavy rainfall events is the main factor for maintaining ¹³⁷Cs concentrations in coastal sediments near the Fukushima Daiichi Nuclear Power Plant.

Multiple Brain Metastases in a Patient with ROS1 Fusion-Positive Lung Adenocarcinoma as a Disease Flare due to Crizotinib Cessation Caused by Disseminated Aseptic Inflammation from Crizotinib-Associated Renal Cysts: A Case Report

Rapid tumor growth after cessation of molecularly targeted drugs, called “disease flare,” may occur and affect the prognosis of lung cancer. However, this phenomenon has never been reported in ROS proto-oncogene 1 (ROS1) fusion-positive lung adenocarcinoma. Herein, we report a disease flare in a patient with ROS1 fusion-positive lung adenocarcinoma. A 60-year-old female was diagnosed with stage IVA ROS1 fusion-positive lung adenocarcinoma via bronchoscopy. Although crizotinib, an ROS1 tyrosine kinase inhibitor, achieved a partial response, a mass lesion appeared in the patient's right kidney 12 months after starting crizotinib, which was diagnosed pathologically as crizotinib-associated renal cysts (CARCs). Given that readministration of crizotinib repeatedly induced CARC-like aseptic inflammation that appeared to be disseminated around surgical site, crizotinib treatment had to be abandoned. Around 25 days after crizotinib cessation, she was referred to the emergency department with a convulsive seizure and hemiparesis due to new, rapidly growing brain metastases. Whole-brain irradiation and administration of another ROS1 tyrosine kinase inhibitor, entrectinib, markedly ameliorated the metastases and improved hemiparesis. This has been the first report of a disease flare after crizotinib cessation due to CARCs in a patient with ROS1 fusion-positive lung adenocarcinoma. Attention should be paid to disease flare, especially in the brain, when molecularly targeted medication is stopped due to adverse events in ROS1 fusion-positive lung adenocarcinoma. Switching to drugs that penetrate the blood-brain barrier could overcome disease flare in the brain.

Factors controlling dissolved 137Cs activities in coastal waters on the eastern and western sides of Honshu, Japan

The distributions of dissolved ¹³⁷Cs in river, nearshore, and offshore waters on the east and west coasts of the Japanese island of Honshu were studied in 2018-2021, 7-10 years after the Fukushima Dai-ichi Nuclear Power Plant (FDNPP) accident. On the east side along the north western North Pacific (Fukushima Prefecture), estuarine processes, including desorption from riverine particles and dissolution into pore water from riverine particles that had settled to the seafloor, contributed to the maintenance of high dissolved ¹³⁷Cs activities in nearshore and offshore waters. A survey and mass-balance calculation in a semi-enclosed estuarine area, the Matsukawa-ura, in the northern part of Fukushima, provided convincing evidence that rivers contributed to the influx of ¹³⁷Cs to coastal waters. In contrast, the extremely low activities of dissolved and particulate ¹³⁷Cs in the Tedori River of Ishikawa Prefecture on the western side of Japan along the Japan Sea suggested that inputs of riverine ¹³⁷Cs made a negligible contribution to the increase of dissolved ¹³⁷Cs activities in the nearshore and offshore waters. The relatively high dissolved ¹³⁷Cs activities observed in the offshore waters of the Japan Sea were due to movement of FDNPP-derived ¹³⁷Cs into the Japan Sea via the Tsushima Warm Current. Mechanisms controlling the distributions of ¹³⁷Cs activities in coastal waters of the eastern and western sides of Japan therefore differ.

Multiple cerebral infarctions in ROS1-rearranged lung adenocarcinoma

Rearrangements of specific tyrosine kinases are associated with an elevated risk of venous thrombosis in lung adenocarcinoma, although their effects on arterial thrombosis have not been fully elucidated. Here, we report two cases of ROS proto-oncogene 1 (ROS1)-rearranged lung adenocarcinoma with cerebral infarction during the peri-diagnostic period. Two cases took contrasting clinical courses: one patient could not receive targeted therapy because of a significant decline in performance status, whereas in the other patient, the performance status was maintained and targeted therapy drastically reduced the tumour size. Our cases suggest close monitoring could be considered in the selected cohort.

Standardized reporting systems of chest computed tomography in a population with low coronavirus disease 2019 prevalence: A retrospective comparative study

Purpose

To compare the diagnostic performance and interobserver agreement of three reporting systems for computed tomography findings in coronavirus disease 2019 (COVID-19), namely the COVID-19 Reporting and Data System (CO-RADS), COVID-19 Imaging Reporting and Data System (COVID-RADS), and Radiological Society of North America (RSNA) expert consensus statement, in a low COVID-19 prevalence area.

Method

This institutional review board approval single-institutional retrospective study included 154 hospitalized patients between April 1 and May 21, 2020; 26 (16.9 %; 63.2 ± 14.1 years, 21 men) and 128 (65.7 ± 16.4 years, 87 men) patients were diagnosed with and without COVID-19 according to reverse transcription-polymerase chain reaction results, respectively. Written informed consent was waived due to the retrospective nature of the study. Six radiologists independently classified chest computed tomography images according to each reporting system. The area under receiver operating characteristic curves, sensitivity, specificity, positive predictive value, negative predictive value, accuracy, and interobserver agreements were calculated and compared across the systems using paired t-test and kappa analysis.

Results

Mean area under receiver operating characteristic curves were as follows: CO-RADS, 0.89 (95 % confidence interval [CI], 0.87–0.90); COVID-RADS, 0.78 (0.75–0.80); and RSNA expert consensus statement, 0.88 (0.86–0.90). Average kappa values across observers were 0.52 (95 % CI: 0.45–0.60), 0.51 (0.41–0.61), and 0.57 (0.49–0.64) for CO-RADS, COVID-RADS, and RSNA expert consensus statement, respectively. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were the highest at 0.71, 0.53, 0.72, 0.96, and 0.56 in the CO-RADS; 0.56, 0.31, 0.54, 0.95, and 0.35 in the COVID-RADS; 0.83, 0.49, 0.61, 0.96, and 0.55 in the RSNA expert consensus statement, respectively.

Conclusions

The CO-RADS exhibited the highest specificity, positive predictive value, which are especially important in a low-prevalence population, while maintaining high accuracy and negative predictive value, demonstrating the best performance in a low-prevalence population.

Blood Glucose Control Strategy for Type 2 Diabetes Patients With COVID-19

Since December 2019, coronavirus disease 2019 (COVID-19) caused by a novel coronavirus has spread all over the world affecting tens of millions of people. Another pandemic affecting the modern world, type 2 diabetes mellitus is among the major risk factors for mortality from COVID-19. Current evidence, while limited, suggests that proper blood glucose control may help prevent exacerbation of COVID-19 even in patients with type 2 diabetes mellitus. Under current circumstances where the magic bullet for the disease remains unavailable, it appears that the role of blood glucose control cannot be stressed too much. In this review the profile of each anti-diabetic agent is discussed in relation to COVID-19.

NRXN1 as a novel potential target of antibody-drug conjugates for small cell lung cancer

Small cell lung cancer (SCLC) is a high-grade malignancy, and treatment strategies have not changed for decades. In this study, we searched for novel targets for antibody-drug conjugate (ADC) therapy for SCLC. We identified transmembrane proteins overexpressed specifically in SCLC with little or no expression in normal tissues and decided to focus on the cell adhesion molecule neurexin-1 (NRXN1). The cell surface overexpression of NRXN1 was confirmed using flow cytometry in SCLC cell lines (SHP77 and NCI-H526). The combination of a primary anti-NRXN1 monoclonal antibody and a secondary ADC exhibited anti-tumor activity in SCLC cell lines. Moreover, the knockout of NRXN1 in SHP77 cells resulted in a loss of the anti-tumor activity of NRXN1-mediated ADC therapy. Thus, NRXN1 could be a novel target for ADC therapy for the treatment of SCLC that is worth further research.

Integrin α11 in non-small cell lung cancer is associated with tumor progression and postoperative recurrence

Integrins are transmembrane proteins that mediate cell adhesion to the extracellular matrix. Integrin α11 (ITGA11) is not expressed in normal alveolar epithelial cells and is a known receptor for collagen. While integrin α11β1 overexpression in the tumor stroma has been associated with tumor growth and metastatic potential of non-small cell lung cancer (NSCLC), little is known about the role of ITGA11 in tumor cells. Thus, we examined the RNA expression of ITGA11 by quantitative RT-PCR in 80 samples collected from NSCLC patients who had undergone surgical resection and analyzed the clinical outcomes. We found that high expression of ITGA11 was associated with lower recurrence-free survival in all NSCLC patients (P = 0.043) and in stage I NSCLC patients (P = 0.049). These results were consistent with in silico analyses of the Cancer Genome Atlas database. We also analyzed cell proliferation, migration and invasion capacity in lung cancer cell lines after overexpression of ITGA11. Overexpression of ITGA11 in lung cancer cell lines had little effect on cell proliferation but resulted in increased migration and invasion capacity. Our findings suggest that ITGA11 plays a significant role in cancer migration and invasion, leading to higher recurrence. ITGA11 expression may be a predictor of poor prognosis in patients with surgically resected NSCLC.

Current-feedback-stabilized laser system for quantum simulation experiments using Yb clock transition at 578 nm

We developed a laser system for the spectroscopy of the clock transition in ytterbium (Yb) atoms at 578 nm based on an interference-filter stabilized external-cavity diode laser (IFDL) emitting at 1156 nm. Owing to the improved frequency-to-current response of the laser-diode chip and the less sensitivity of the IFDL to mechanical perturbations, we succeeded in stabilizing the frequency to a high-finesse ultra-low-expansion glass cavity with a simple current feedback system. Using this laser system, we performed high-resolution clock spectroscopy of Yb and found that the linewidth of the stabilized laser was less than 320 Hz.

Identification of a metastatic lung adenocarcinoma of the palate mucosa through genetic and histopathological analysis: a rare case report and literature review

Background

Cancers of unknown primary origin (CUPs) are reported to be the 3-4th most common causes of cancer death. Recent years have seen advances in mutational analysis and genomics profiling. These advances could improve accuracy of diagnosis of CUPs and might improve the prognosis of patients with CUPs.

Case presentation

A 76-year old male with an adenocarcinoma of unknown primary origin in the lung presented with another tumor of the palate mucosa. The tumor cells in the pleural effusion were all negative for immunohistochemical markers (TTF-1 and Napsin A) and lung-specific oncogenic driver alterations (EGFR mutation and ALK translocation). The tumor of the palate mucosa was likewise identified as an adenocarcinoma, and the cells showed cytological similarities with the tumor cells in the pleural effusion; TTF-1, Napsin A, EGFR mutation and ALK translocation were all negative. This result suggested that origins of the tumors of the palate mucosa and in the lung were the same, even though the origin had not yet been determined. Next, we addressed whether the tumor of the palate mucosa was a primary tumor or not. Secretory carcinoma (SC), which is a common type of minor salivary gland tumor (MSGT), was suspected; however, mammaglobin was negative and ETV6-NTRK3 (EN) fusion was not observed. Other MSGTs were excluded based on histological and immunohistochemical findings. Furthermore, an additional examination demonstrated an oncogenic KRAS mutation at codon 12 (p.G12D) in both palate tumor and in pleural effusion. KRAS mutation is known to exist in one-third of lung adenocarcinomas (LUADs), but quite rare in MSGTs. The possibility of metastasis from other organs was considered unlikely from the results of endoscopic and imaging studies. This result indicated that the primary site of the CUP was indeed the lung, and that the tumor of the palate mucosa was a metastasis of the LUAD.

Conclusions

A tumor of the palate mucosa that showed diagnostic difficulties was determined to be a metastatic LUAD by genomic alterations and histopathological findings.

Electronic supplementary material

The online version of this article (10.1186/s12885-019-5277-1) contains supplementary material, which is available to authorized users.

Mean platelet volume and lymphocyte-to-monocyte ratio are associated with shorter progression-free survival in EGFR-mutant lung adenocarcinoma treated by EGFR tyrosine kinase inhibitor

Background

A growing body of evidence supports the role of platelets in cancer metastasis, escape from immune surveillance, and angiogenesis. Mean platelet volume (MPV), which reflects platelet turnover, is reported routinely as part of automated complete blood count. Accumulating evidence suggests that MPV is a useful biomarker in several diseases including cancer. However, its role in cancer patients receiving molecular targeted therapy has not been described in the literature.

Materials and methods

We retrospectively analysed the prognostic impact of MPV in advanced or recurrent EGFR mutant lung adenocarcinoma treated with EGFR tyrosine kinase inhibitors (EGFR-TKIs). Lymphocyte-to-monocyte ratio (LMR) has been previously reported to be a poor prognostic factor in EGFR mutant non-small cell lung cancer and was also included as a covariate.

Results

Using the previously described Cutoff Finder algorithm, the cut-off points for MPV and LMR that best predicted progression free survival (PFS) of EGFR-TKI were determined as 10.3 and 2.8, respectively. The median PFS was 14.7 and 8.2 months in MPV low and high groups (p = 0.013, log-rank test). The median PFS was 13.5 and 6.2 months in LMR high and low groups (p < 0.001, log-rank test). MPV and LMR were independently distributed (chi square test) and the multivariate analysis using Cox’s proportional hazards regression model revealed that high MPV, low LMR, and pleural effusion were significant predictors for shorter PFS.

Conclusion

MPV and LMR, measured as part of routine complete blood count, can be utilized to predict the outcome of EGFR-TKI therapy with no additional costs. Our results suggest a mechanism of EGFR-TKI resistance which is associated with the functional status of the platelets.

Altered editing level of microRNAs is a potential biomarker in lung adenocarcinoma

Adenosine‐to‐inosine (A‐to‐I) microRNA editing is associated with tumor phenotypes in various cancer types. Recent analyses of The Cancer Genome Atlas (TCGA) dataset have shown several microRNAs that undergo A‐to‐I editing in human cancers, some of which have been reported to be associated with prognosis. Herein, we examined published small RNA deep sequencing data of 74 cases of lung adenocarcinoma (AD) and the corresponding normal counterpart (NC) specimen in silico in order to identify A‐to‐I microRNA editing events. Editing levels of miR‐379‐5p, miR‐99a‐5p, and miR‐497‐5p were lower in AD than in NC and, in a large number of cases, the editing level of miR‐200b‐3p was higher in AD than in NC. Difference in the editing level between AD and NC was largest for miR‐99a‐5p. Then, we examined the editing level of miR‐99a‐5p in 50 surgically resected lung adenocarcinoma cases at our institution by a conventional sequence‐based method, and its association with clinical outcomes. The editing level of miR‐99a‐5p was significantly lower in 19 cases of AD (38%) than in corresponding NC. These cases showed a shorter overall survival as assessed using the log‐rank test (P = .047). This trend was consistent with previous analyses of TCGA dataset. The altered editing level of microRNAs in lung adenocarcinoma could serve as a potential biomarker.

Abstract A31: Loss of RNA editing of miR-99a-5p is a potential prognostic biomarker in completely resected lung adenocarcinoma

Adenosine-to-Inosine (A-to-I) RNA editing of microRNAs affects tumor phenotypes in various cancer types both in vitro and in vivo. For example, in melanoma cell lines, reduced RNA editing in miR-455-5p promotes metastasis through inhibition of a tumor-suppressor gene, CPEB1. For another example, in glioblastoma cell lines, accumulation of unedited miR-376a-3p and downregulation of edited miR-376a-3p promotes migration and invasion through inhibition of RAP2A and upregulation of AMFR, respectively. However, the difference in the editing level of microRNAs between cancers and the corresponding noncancerous tissues in humans is largely unknown.

In this study, we examined microRNA deep sequencing data in silico. The previously reported perl scripts to detect microRNA editing events used release 18 (November 2011) from miRBase as reference. Therefore, we revised the scripts to use the latest version, release 21 (June 2014). Analysis of public data of 74 cases of lung adenocarcinoma from sequence read archive (SRA) revealed eight microRNAs that underwent A-to-I RNA editing in at least five cases of both the tumor samples and the corresponding noncancerous samples. The editing levels of miR-379-5p, miR-99a-5p, and miR-497-5p were lower in the tumor samples than in the normal counterparts. The editing level of miR-200b-3p was higher in the tumor samples than in the normal counterparts. Among these four microRNAs, miR-99a-5p showed the largest difference in the editing level between the tumors and the normal counterparts.

Then we examined the editing level of miR-99a-5p in 50 cases of surgically resected lung adenocarcinoma at our institution by an original conventional sequence-based method. The editing level of miR-99a-5p was significantly lower in the tumor samples than the corresponding noncancerous samples in 19 cases (38%). The loss of RNA editing of miR-99a-5p was not associated with any clinical characteristics, such as sex, smoking history, pathologic stage, and EGFR mutation. These 19 cases showed a tendency toward a shorter recurrence-free survival (RFS) using the log rank test (P = 0.103) and a Cox proportional hazards model (hazard ratio, 1.91; 95% confidence interval, 0.87-4.19; P = 0.109). These results indicate that the loss of RNA editing of miR-99a-5p is a potential prognostic biomarker in patients with completely resected lung adenocarcinoma.

Citation Format: Keita Maemura, Kousuke Watanabe, Takahiro Ando, Noriko Hiyama, Toshio Sakatani, Yosuke Amano, Hidenori Kage, Daiya Takai. Loss of RNA editing of miR-99a-5p is a potential prognostic biomarker in completely resected lung adenocarcinoma [abstract]. In: Proceedings of the Fifth AACR-IASLC International Joint Conference: Lung Cancer Translational Science from the Bench to the Clinic; Jan 8-11, 2018; San Diego, CA. Philadelphia (PA): AACR; Clin Cancer Res 2018;24(17_Suppl):Abstract nr A31.

Abstract B22: Exposure of AZD4547 FGFR-TKI to a lung squamous carcinoma cell line induces resistance by small cell lung cancer-like transformation associated with ASCL1

Molecular targeted medicine has progressed in non-small cell lung cancer in recent years, and acquired resistance to molecular targeted therapy has become a major problem. Several mechanisms of acquired resistance have been described, such as secondary mutation of targeted genes, bypass pathway activation, and phenotypic transformation, including epithelial-mesenchymal transition and small cell lung cancer transformation. However, detailed mechanisms and the strategy to overcome the resistance have yet to be clarified thoroughly. In this study, we established a squamous lung cancer cell line with acquired resistance to FGFR tyrosine kinase inhibitor in vitro and identified achaete-scute family bHLH transcription factor 1 (ASCL1) overexpression as a mechanism of the resistance to tyrosine kinase inhibitor treatment.

We identified LK-2 as a squamous cell lung cancer cell line that is highly sensitive to FGFR tyrosine kinase inhibitor AZD4547, which is currently evaluated in clinical trial in squamous cell lung cancer, and established its resistant clone in vitro by exposing gradually increasing concentration of AZD4547. The resistant clone was morphologically more round-shaped and expressed ASCL1 significantly higher than the original LK-2 in a microarray analysis, but did not have additional mutations in putative genes responsible for resistance in RNA-sequencing. ASCL1 inhibition with shRNA lentivirus did not restore the sensitivity to AZD4547, but significantly suppressed the growth of the resistant clone compared to the original LK-2. Cyclin A1 (CCNA1) expression was also increased in the resistant clone and was regulated by ASCL1. CCNA1 inhibition also suppressed the growth of the resistant clone.

These results suggest that ASCL1 was one of the key molecules for the acquired resistance to tyrosine kinase inhibitor therapy, and considering the evidence that ASCL1 is a master regulator of small cell lung cancer-like phenotype, it may be related to small cell lung cancer transformation as a mechanism of the resistance. ASCL1 and its downstream molecule CCNA1 may be candidates to overcome the resistance to tyrosine kinase inhibitor therapy.

Citation Format: Yosuke Amano, Takahiro Ando, Keita Maemura, Toshio Sakatini, Mitsuhiro Sunohara, Kosuke Watanabe, Hidenori Kage. Exposure of AZD4547 FGFR-TKI to a lung squamous carcinoma cell line induces resistance by small cell lung cancer-like transformation associated with ASCL1 [abstract]. In: Proceedings of the Fifth AACR-IASLC International Joint Conference: Lung Cancer Translational Science from the Bench to the Clinic; Jan 8-11, 2018; San Diego, CA. Philadelphia (PA): AACR; Clin Cancer Res 2018;24(17_Suppl):Abstract nr B22.

Glutamate-cysteine ligase catalytic subunit is associated with cisplatin resistance in lung adenocarcinoma

Background

Cisplatin is a key drug for treating lung adenocarcinoma, and its sensitivity to cisplatin is directly related to prognosis. We aimed to reveal the roles of genes related to glutathione synthesis (glutamate-cysteine ligase catalytic subunit, GCLC) and cystine uptake (cystine/glutamate transporter, xCT and CD44v8-10) in cisplatin resistance and prognosis in lung adenocarcinoma.

Methods

We established cell lines stably expressing GCLC, xCT, standard isoform of CD44, and CD44v8-10, and investigated their sensitivities to cisplatin. We also measured mRNA expression levels of these genes in the tumor tissues from 92 lung adenocarcinoma patients. Patients were divided into high-expression (upper quartile, N = 23) and low-expression groups (remaining patients, N = 69). Recurrence-free survival, overall survival (N = 92), and post-recurrence survival (N = 22) were selected as endpoints.

Results

Compared with the control green fluorescent protein-expressing cell line (inhibitory concentration 50:6.9 μM), all the stable cell lines were more resistant to cisplatin (12.9 μM, P = 0.025; 13.9 μM, P = 0.028; 26.7 μM, P = 0.001; 17.7 μM, P = 0.008, respectively). In contrast, there was no significant difference in recurrence-free or overall survival between the high- and low-expression groups for any of the genes. However, high expression of GCLC was a risk factor for poorer post-recurrence survival (hazard ratio, 6.26; 95% confidence interval, 1.37–28.7; P = 0.018).

Conclusion

High expression levels of genes related to glutathione synthesis and cystine uptake promote cisplatin resistance in lung adenocarcinoma cell lines. High expression of GCLC in tumor tissue may be a potential predictor of treatment failure.

Early stage non-small cell lung cancer patients need brain imaging regardless of symptoms

BACKGROUND

Japanese Lung Cancer Society and ESMO guideline recommends screening for brain metastasis in all patients with non-small cell lung cancer (NSCLC), while NCCN/ACCP guidelines do not recommend screening patients who are asymptomatic and with clinical stage I NSCLC. However, brain metastasis sometimes occurs in early stage NSCLC patients without any neurological symptoms.

METHODS

We retrospectively reviewed medical records of 124 patients admitted to the University of Tokyo Hospital with stage IV NSCLC from January 2012 to April 2016. We analyzed clinical stage, the presence of the central nervous system manifestations and the number of brain metastases.

RESULTS

Forty-six out of 124 cases had brain metastasis at presentation. The brain metastasis group had larger number of female, never smokers and patients with EGFR mutation compared with extracranial metastasis group. Twenty-one of 35 adenocarcinoma cases with brain metastasis had EGFR mutations. Out of 46 brain metastasis patients, 29 patients (63%) were asymptomatic and patients with EGFR mutations were significantly less likely to have neurological symptoms (4/21 vs. 7/14, p = 0.049). Six out of 46 cases with brain metastasis (13%) were clinical T1-2aN0. In clinical T1-2aN0 cases, only one patient had neurological symptoms at presentation.

CONCLUSION

In clinical T1-2aN0 lung cancer patients with brain metastasis, almost all patients were asymptomatic. Patients with EGFR mutations and brain metastasis were likely to be asymptomatic. Regardless of central nervous system symptoms, routine brain imaging seems warranted in all NSCLC patients, especially in areas where patients have a higher frequency of EGFR mutations.

Acute Arterial Thrombosis during Postoperative Adjuvant Cisplatin-based Chemotherapy for Completely Resected Lung Adenocarcinoma

A malignant tumor can cause hypercoagulation and it also often coexists with thrombosis. Cisplatin-based chemotherapy can also induce adverse vascular effects, including arterial thrombosis. We herein report a case of acute arterial thrombosis in a patient undergoing postoperative adjuvant cisplatin-based chemotherapy for completely resected lung cancer. The patient complained of acute leg pain after chemotherapy, and computed tomography revealed multiple thrombi from the thoracic to popliteal arteries. Arterial thrombosis during adjuvant chemotherapy is extremely rare; however, careful clinical observation of patients receiving cisplatin-based chemotherapy is important, because arterial thrombosis, even in the absence of the primary malignant tumor, is possible.

High expression of IRE1 in lung adenocarcinoma is associated with a lower rate of recurrence

Objective

Recent reports have shown that endoplasmic reticulum stress is associated with cancer. However, the impacts of endoplasmic reticulum stress on the prognosis of lung cancer are unknown. Therefore, in this study, we sought to reveal the relationship between the expression of endoplasmic reticulum stress-related genes (endoplasmic reticulum oxidoreductase 1L, protein kinase RNA-like endoplasmic reticulum kinase, activating transcription factor 6 and inositol-requiring kinase 1) and the outcome of lung adenocarcinoma.

Methods

One hundred and twenty-six patients with surgically resected lung adenocarcinomas were subjected to an endoplasmic reticulum stress-related mRNA expression analysis using quantitative RT-PCR. The following parameters were analyzed for all the study patients: age, sex, disease stage, smoking status, lymph node invasion (ly), vascular invasion (v) and EGFR mutation status. We assigned patients to either a high-expression group or a low-expression group according to the expression levels of endoplasmic reticulum stress-related genes.

Results

High expressions of endoplasmic reticulum stress-related genes were observed in patients with lower stages of lung adenocarcinoma and minimal vascular invasion. A Kaplan–Meier analysis showed significant differences in recurrence-free survival and overall survival between high-expression group and low-expression group. High inositol-requiring kinase 1 expression was an independent predictor of recurrence-free survival among patients with lung adenocarcinoma (hazard ratio, 0.396; 95% confidence interval, 0.188–0.834; P = 0.015).

Conclusions

Inositol-requiring kinase 1 may be a useful biomarker to predict recurrence in surgically resected lung adenocarcinoma patients.

Old age and underlying interstitial abnormalities are risk factors for development of ARDS after pleurodesis using limited amount of large particle size talc

BACKGROUND AND OBJECTIVE

Talc pleurodesis is commonly performed to manage refractory pleural effusion or pneumothorax. It is considered as a safe procedure as long as a limited amount of large particle size talc is used. However, acute respiratory distress syndrome (ARDS) is a rare but serious complication after talc pleurodesis. We sought to determine the risk factors for the development of ARDS after pleurodesis using a limited amount of large particle size talc.

METHODS

We retrospectively reviewed patients who underwent pleurodesis with talc or OK-432 at the University of Tokyo Hospital.

RESULTS

Twenty-seven and 35 patients underwent chemical pleurodesis using large particle size talc (4 g or less) or OK-432, respectively. Four of 27 (15%) patients developed ARDS after talc pleurodesis. Patients who developed ARDS were significantly older than those who did not (median 80 vs 66 years, P = 0.02) and had a higher prevalence of underlying interstitial abnormalities on chest computed tomography (CT; 2/4 vs 1/23, P < 0.05). No patient developed ARDS after pleurodesis with OK-432. This is the first case series of ARDS after pleurodesis using a limited amount of large particle size talc.

CONCLUSION

Older age and underlying interstitial abnormalities on chest CT seem to be risk factors for developing ARDS after talc pleurodesis.

Cardiogenic syncope possibly related to bevacizumab-containing combination chemotherapy for advanced non-small cell lung cancer

We report the case of a 55-year-old man with stage IV lung adenocarcinoma who received carboplatin-paclitaxel-bevacizumab chemotherapy as second-line therapy. After four cycles of chemotherapy, he experienced syncope with a decrease in blood pressure. Electrocardiography (ECG) revealed atrial fibrillation. Cardiac ultrasonography showed a markedly reduced ejection fraction (45%), with moderate decrease in comparison to that before chemotherapy (66%). Bisoprolol fumarate was initiated, and the conversion to sinus rhythm was detected by ECG 4 days after the syncope. At that time, no improvement in the ejection fraction was detected. Bevacizumab-associated cardiotoxicity was suspected, and bevacizumab maintenance therapy was discontinued, although the chemotherapy achieved a stable disease status based on the Response Evaluation Criteria in Solid Tumors. Two months after bevacizumab cessation, the ejection fraction improved to pretreatment level (62%). To the best of our knowledge, this is the first report on cardiogenic syncope due to left ventricular dysfunction that is most consistent with bevacizumab-associated cardiotoxicity in non-small cell lung cancer (NSCLC). Our results indicate that bevacizumab could lead to cardiotoxicity in patients with NSCLC and suggest the importance of the follow-up cardiac ultrasonography.

Quantitative Evaluation of Intraarterial Lymphocyte Injection Therapy for Lymph Edema Using MR Imaging

Five patients with unilateral leg lymph edema had intraarterial injections of lymphocytes in the affected leg with consequent improvement in 3. To assess the degree of lymph edema, T2 and intensity ratio between the 2 legs in STIR images were used. Mean and SD of T2 values in the subcutaneous tissue were measured using a triple echo sequence and found larger on the edematous side than in the opposite extremity. The mean T2 shortening obtained after the lymphocyte therapy correlated well with the reduction of limb circumference. Mean T2 reflects the fluid content, and SD of T2 the fluid distribution in the subcutaneous tissue. The degree of lymph edema and the effect of therapy can be evaluated quantitatively by measuring the value of the T2 relaxation time.

Contrast-enhanced T1-weighted black-blood fast spin-echo MR imaging of the brain: Technique for suppression of enhancing venous signal

Purpose: Contrast-enhanced T1-weighted black-blood fast spin-echo MR imaging (BB-FSE) was performed to suppress enhancing venous signal and flow artifacts in the brain without sacrificing the T1-weighted imaging contrast.

Material and Methods: Twenty-five MR imaging sections (17 transverse and 8 coronal images) in 15 patients with various brain diseases were obtained by contrast-enhanced T1-weighted SE and BB-FSE images.

Results: In contrast-enhanced T1-weighted BB-FSE images, venous signal was significantly less and T1-weighted contrast of the brain was more evident. No differences in flow artifacts were found between the two imaging techniques. The interobserver agreements were good for the venous signal and flow artifacts using both techniques.

Conclusion: Contrast-enhanced T1-weighted BB-FSE imaging reduced the venous signal in the brain with maintaining T1-weighted contrast. This novel MR technique can be used when the suppression of enhancing venous signal is expected to improve the depiction of enhancing lesions in the brain.

Development of Pulmonary Artery Aneurysms Due to Behçet's Disease and Resolution after Treatment

We herein describe a patient with Behçet's disease in whom we followed the development and resolution of pulmonary artery aneurysms. He presented with intermittent hemoptysis, pulmonary thromboembolism was initially diagnosed, and anticoagulant therapy was started. Over the next several months, the expansion of pulmonary arteries was noted. Five months after his initial admission, he was readmitted for massive hemoptysis, and further examinations revealed that he had Behçet's disease. Corticosteroids and intravenous cyclophosphamide were started. Over the next five months, the pulmonary artery aneurysms and thrombosis resolved. The development of pulmonary artery aneurysms led to the diagnosis of Behçet's disease, and they resolved after immunosuppressive therapy.

The chimeric transcript RUNX1-GLRX5: a biomarker for good postoperative prognosis in Stage IA non-small-cell lung cancer

Stage IA non-small-cell lung cancer cases have been recognized as having a low risk of relapse; however, occasionally, relapse may occur. To predict clinical outcome in Stage IA non-small-cell lung cancer patients, we searched for chimeric transcripts that can be used as biomarkers and identified a novel chimeric transcript, RUNX1–GLRX5, comprising RUNX1, a transcription factor, and GLRX5. This chimera was detected in approximately half of the investigated Stage IA non-small-cell lung cancer patients (44/104 cases, 42.3%). Although there was no significant difference in the overall survival rate between RUNX1–GLRX5-positive and -negative cases (P = 0.088), a significantly lower relapse rate was observed in the RUNX1–GLRX5-positive cases (P = 0.039), indicating that this chimera can be used as a biomarker for good prognosis in Stage IA patients. Detection of the RUNX1–GLRX5 chimeric transcript may therefore be useful for the determination of a postoperative treatment plan for Stage IA non-small-cell lung cancer patients.

Histone methylation-mediated silencing of miR-139 enhances invasion of non-small-cell lung cancer

MicroRNA expression is frequently altered in human cancers, and some microRNAs act as oncogenes or tumor suppressors. MiR-139-5p (denoted thereafter as miR-139) has recently been reported to function as a tumor suppressor in several types of human cancer (hepatocellular carcinoma, colorectal cancer, breast cancer, and gastric cancer), but its function in non-small-cell lung cancer (NSCLC) and the mechanism of its suppression have not been studied in detail. MiR-139 was suppressed frequently in primary NSCLCs. MiR-139 is located within the intron of PDE2A and its expression was significantly correlated with the expression of PDE2A. A chromatin immunoprecipitation assay revealed that miR-139 was epigenetically silenced by histone H3 lysine 27 trimethylation (H3K27me3) of its host gene PDE2A and this process was independent of promoter DNA methylation. Pharmacological inhibition of both histone methylation and deacetylation-induced miR-139 with its host gene PDE2A. Ectopic expression of miR-139 in lung cancer cell lines did not affect the proliferation nor the migration but significantly suppressed the invasion through the extracellular matrix. In primary NSCLCs, decreased expression of miR-139 was significantly associated with distant lymph node metastasis and histological invasiveness (lymphatic invasion and vascular invasion) on both univariate and multivariate analyses. Collectively, these results suggest that H3K27me3-mediated silencing of miR-139 enhances an invasive and metastatic phenotype of NSCLC.

[On the notes of the Xinkan Huangdimingtangjiujing (see text for symbol) in the possession of the National Diet Library]

This paper analyzes the notes of Xinkan huangdimingtangjiujing which are in the possession of the National Diet Library, particularly referring to those notes which include "master said", or "master's theory". Some of those are found in the answers from Manase Dosan (see text for symbol) to Hata Soha (see text for symbol) collected in the Kotei meido kyukyo hushin shosho (see text for symbol) which is the record of the question and answer letters between Manase Dosan and Hata Soha. This research indicates that this volume has a close relation to the acupuncture research of Dosan's or Soha's school. And it indicates that the "master" in the Notes of Xinkan huangdimingtangjiujing refers to Dosan. Acupuncture research has been flourishing since the Edo era and has compiled a lot of volumes on acupuncture. This volume contains some pioneering pieces of this research done in the Azuchi Momoyama era by Dosan and Soha, and is a precious material, showing that some of the state of affairs of the research done in that age still remains today.

Detection of novel paraja ring finger 2-fer tyrosine kinase mRNA chimeras is associated with poor postoperative prognosis in non-small cell lung cancer

Previously, we reported that the overexpression of fer tyrosine kinase (FER), a non-receptor tyrosine kinase, is correlated with poor postoperative prognosis and cancer-cell survival in non-small cell lung cancer (NSCLC). In the present study, we further analyzed FER-overexpressed NSCLC cases and identified various patterns of chimeric mRNAs, composed of paraja ring finger 2 (PJA2) and FER. We detected no genomic rearrangements between PJA2 and FER and attributed these chimeric mRNAs to alterations at the transcriptome level: i.e., trans-splicing. Several chimeric patterns were detected concurrently in each patient, and the pattern sets varied among patients, although the pattern in which PJA2 exon 1 was fused to FER exon 3 (designated as Pe1-Fe3 mRNA) was detected constantly. Therefore, in a wide screening for PJA2-FER mRNAs in NSCLC, we focused on this chimeric pattern as a representative chimera. In analyses of 167 NSCLC samples, Pe1-Fe3 mRNA was identified in about 10% of the patients, and the presence of chimeric mRNA was significantly correlated with a high expression level of parental FER mRNA. Furthermore, we found that the detection of Pe1-Fe3 mRNA was correlated with poor postoperative survival periods in NSCLC, consistent with a previous finding in which FER overexpression was correlated with poor postoperative prognosis in NSCLC. This report is the first to suggest a correlation between chimeric mRNA and the expression level of parental mRNA. Furthermore, our findings may be clinically beneficial, suggesting that PJA2-FER mRNAs might serve as a novel prognostic biomarker in NSCLC.

FER overexpression is associated with poor postoperative prognosis and cancer-cell survival in non-small cell lung cancer

Here, we show that overexpression of fer tyrosine kinase (FER), a non-receptor tyrosine kinase, predicts poor postoperative outcome and might be involved in cancer-cell survival in non-small cell lung cancer (NSCLC). Systematic screening using in silico analyses and quantitative RT-PCR revealed that FER was overexpressed in about 10% of NSCLC patients. Evaluation of FER expression using immunohistochemistry (IHC) on tissue microarrays was consistent with the mRNA level detected using quantitative RT-PCR. In analyses of 135 NSCLC patients who had undergone potential curative resection, we found that FER overexpression detected using IHC had no association with clinicopathological features such as age, sex, smoking history, histological type, disease stage, T factor, N factor, adjuvant chemotherapy history, or EGFR mutation, but was correlated with poor postoperative survival periods. A multivariate Cox regression analysis showed that this prognostic impact was independent of other clinicopathological features. In functional analyses of FER in vitro, FER exhibited a transforming activity, suggesting that it possesses oncogenic functions. We also found that human lung cancer NCI-H661 cells, which exhibited FER-outlier expression, were led to apoptosis by the knockdown of FER using RNA interference. FER overexpression might serve as a prognostic biomarker and be involved in cancer-cell survival in NSCLC.

Ovulation day after onset of vulval bleeding in a beagle colony

This study investigated the duration of the interval between the onset of vulval bleeding at pro-oestrus and ovulation estimated from the plasma progesterone concentration in a large number of beagle bitches. The influence and association of individual variation, ageing and duration of the oestrous cycle were also investigated. The mean time of ovulation after the onset of vulval bleeding was 11.1 ± 0.2 days, but it widely ranged from 3 to 31 days. This timing was not influenced by age or duration of the oestrous cycle, and within-individual variation was small. As there has been no previous report in which the ovulation day was investigated by the age, these data may be very valuable.

Community structure of planktonic fungi and the impact of parasitic chytrids on phytoplankton in Lake Inba, Japan

Freshwater fungi have received little attention by scientific research in recent years, especially fungi of the pelagic zone. Recently, parasitic fungi, termed chytrids, have been found to play important roles in aquatic food webs. Yet, the diversity and community structure of planktonic fungi including chytrids are not well studied. In this study, we examined the temporal fluctuations of freshwater fungi, including chytrids, in Lake Inba by using molecular techniques of denaturing gradient gel electrophoresis (DGGE). DGGE profiles, and associated sequence analysis, indicated that chytrids were present on all sampling dates from May to October (n = 12). In addition, analysis showed that a large proportion of the sequences belonged to chytrids of both parasitic and saprotrophic species. This finding was supported by microscopic observations using Calcofluor white to stain chytrids infecting various phytoplankton species. The percentages of infection by chytrids on two dominant diatom species, Aulacoseira granulata and Aulacoseira ambigua, showed a similar seasonal pattern in the DGGE band profiles. From the phylogenetic analysis and microscopic identification, the chytrids infecting the two diatoms are likely to be affiliated to Chytriomyces sp. and Zygorhizidium sp.. This is the first study to show that DGGE is a useful preliminary approach for examining the diversity of planktonic fungi including chytrids. Our results indicate both parasitic and saprotrophic chytrids are a significant component of freshwater fungi inhabiting the pelagic zone of Lake Inba, Japan. Further modification of DGGE, together with new molecular techniques and microscopic observation, would reveal the hidden diversity and ecological significance of planktonic fungi in aquatic ecosystems.

Abstract B39: Genome structure-based screening identified epigenetically silenced microRNA associated with invasiveness in non-small-cell lung cancer

microRNA expression is frequently altered in human cancers. Epigenetic silencing, especially DNA methylation, is one of many mechanisms of microRNA suppression in cancer. To search for epigenetically silenced microRNAs in non-small-cell lung cancer (NSCLC), we mapped human microRNAs on autosomal chromosomes and selected in silico 55 microRNAs that met one of the following criteria: (i) microRNAs within CpG islands, (ii) microRNAs within 1 kbp downstream of CpG islands, and (iii) microRNAs within gene introns whose promoters have CpG islands. We treated six NSCLC cell lines with the DNA methylation inhibitor 5-aza-2′-deoxycytidine (5-aza-CdR) and determined the expressions of the 55 microRNAs. Fourteen microRNAs (mir-375, mir-196b, mir-126, mir-34b, mir-127, mir-203, mir-148a, mir-181c, mir-30e, mir-449a, mir-340, mir-486, mir-483, mir-139) were decreased in the cancer cell lines and were induced after 5-aza-CdR treatment. Among the 14 microRNAs, seven (mir-126, mir-34b, mir-203, mir-30e, mir-449a, mir-486, mir-139) were frequently suppressed in primary NSCLCs. After a detailed DNA methylation analysis, we found that mir-34b and mir-126 were silenced by DNA methylation. Mir-34b was silenced by the DNA methylation of its own promoter, while mir-126 was silenced by the DNA methylation of its host gene, EGFL7. A chromatin immunoprecipitation assay revealed H3K9me2 and H3K9me3 in mir-34b and EGFL7, and H3K27me3 in EGFL7. A significant enrichment of H3K27me3 was observed in lung cancer cell lines with decreased mir-126 expression, suggesting the involvement of a polycomb complex in the regulation of EGFL7 and mir-126. The overexpression of mir-34b and mir-126 by plasmid vectors decreased the expression of c-Met and Crk, respectively. The 5-aza-CdR treatment of lung cancer cell line resulted in increased mir-34b expression and decreased c-Met protein. We next analyzed the DNA methylation status of these microRNAs using 99 primary NSCLCs. Mir-34b and mir-126 were methylated in 41% and 7% of all the cases, respectively. The DNA methylation of mir-34b was not associated with c-Met expression determined by immunohistochemistry, but both mir-34b methylation (p = 0.007) and c-Met expression (p = 0.005) were significantly associated with lymphatic invasion in a multivariate analysis. The DNA methylation of mir-34b can be used as a biomarker for an invasive phenotype of lung cancer.

Adult rat hepatocytes cultured on an oxygen-permeable film increases the activity of albumin secretion

Primary culture of rat hepatocyte was performed in an oxygen-permeable film dish (F-dish), which would be expected to give an oxygen-rich culture condition. In the conventional culture dish in which the depth of medium was 2 mm, the oxygen tension (pO(2)) in the medium decreased from 19% (144 mmHg) to 0.3% (2.3 mmHg) within 2 hr, while the pO(2) in the F-dish maintained 8.5% (64.6 mmHg) even after 2 hr. The adverse effect of the oxygen-deficiency appeared in the albumin secretion activity of the hepatocytes and it was more remarkable in the early period of culture. The average rate of albumin secretion for the initial 48 hr was 2.0 mug ml(-1) hr(-1) or 96 mug 10(6) cells(-1) day(-1) in the F-dish. The average rate of albumin secretion for the initial 12 hr was only 0.36 mug ml(-1) hr(-1) in the conventional culture dish. The activity of ammonia elimination in the F-dish was 20-50% higher than the conventional culture dish. Three-dimensional aggregate was formed only in the F-dish. The advantage of three-dimensional aggregate for albumin secretion was not clear compared with two-dimensional monolayer.