Oral sodium hyaluronate relieves knee discomfort: A 12‑week double‑blinded, placebo‑controlled study

Sodium hyaluronate (SH) is a high molecular-weight polysaccharide composed of repeating polymeric disaccharides of D-glucuronic acid and N-acetyl-D-glucosamine. SH is present in every connective tissue and organ, with synovial fluid having the highest concentration of SH in the body. The effectiveness of oral SH on gonarthrosis is known; although, its influence on the knees of healthy individuals is not. However, as severe diseases may require surgery, it is better to take care of healthy knees before the onset of gonarthrosis. Therefore, the present study investigated the functionality of SH on the knee of healthy individuals. The present study was a randomized double-blind, placebo-controlled trial in which healthy adults (mean age: Placebo group, 61.50±1.59; SH group, 58.50±1.81), rated as grade ≤1 based on the Kellgren-Lawrence classification, were administered 111 mg/day SH for 12 weeks. The evaluation of visual analog scales were performed to assess the discomfort in the knees of the participants and were conducted at baseline, and then 6 and 12 weeks after the start of SH ingestion. Additionally, a locomotive syndrome risk test quantifying the mobility of the participants, a one-leg standing time with eyes open test evaluating the strength of the leg muscle as well as the ability to balance by measuring the time to stand on one leg and a blood test (interleukin-10, aspartate aminotransferase, alanine transaminase, γ-glutamyl transferase, lactate dehydrogenase, creatine kinase and C-reactive protein) were performed at baseline and then 12 weeks after the start of SH ingestion. A significant suppression of knee symptoms were demonstrated in the SH group compared with the placebo group in terms of the total visual analog scale scores for pain, stiffness and discomfort for the 31 healthy adult subjects. Significant suppression of symptoms was also demonstrated in the placebo group in terms of discomfort in the knees when descending stairs and pain in the knees after walking for a longer distance or duration than normal. No significant differences between the two groups were demonstrated in the locomotive syndrome risk test, one-leg standing time with eyes open test and the blood test. The results of the present study suggest the possibility that oral SH may help to maintain a healthy condition of the knees. The study protocol was registered with the University Hospital Medical Information Network Clinical Trial Registry in advance (registration no. UMIN000045980, November 4, 2021).

Assessing the Postprandial Glycemic Response to Japonica Rice (Oryza sativa L. cv. Koshihikari) with a Small Amount of Lysolecithin and Canola Oil in Japanese Adult Men: a Double-blind, Placebo-controlled, Crossover Study

A double-blind, placebo-controlled, crossover trial was performed to analyze the effects of a small amount of lysolecithin and canola oil on blood glucose levels after consuming japonica rice. Overall, 17 Japanese adult men were assigned to consume 150 g of normally cooked japonica rice (placebo group) and 150 g of japonica rice cooked with 18 mg of lysolecithin and 1.8 g of canola oil (treatment group); these lipids were added as emulsified formulation (EMF) for stability and uniformity. Subsequently, blood samples were collected before and 30, 45, 60, 90, and 120 min after consuming test foods. There was no significant difference in blood glucose, insulin, and triglyceride levels between the groups. However, a stratified analysis of 11 subjects with body mass index (BMI) ≥ 22 revealed that blood glucose levels were significantly lower after 30 min in the treatment group than in the placebo group (p = 0.041). Through in vitro digestibility test, the rice sample of the treatment group was observed to release significantly less glucose within 20 min than that in the placebo group rice. These results suggest that the combination of a small amount of lysolecithin and canola oil modulated the increase in postprandial blood glucose levels induced by the intake of cooked japonica rice in adult men with BMI ≥ 22. This clinical trial was registered with the University Hospital Medical Information Network (UMIN) Center, (UMIN000045744; registered on 15/10/2021).

Fibrocystic breast disease with pleomorphic calcifications and segmental distribution: A case report

Fibrocystic breast disease is the most common benign condition and is important for differentiating breast cancer. We present the case of a 27-year-old female patient with pleomorphic calcifications and segmental distribution on mammography, which was highly suggestive of breast cancer; however, the pathological findings were fibrocystic disease. Although fibrocystic breast disease does not require treatment, appropriate follow-up is necessary after assessing the risk of breast cancer.

Ingestion of vegetable salads before rice inhibits the increase in postprandial serum glucose levels in healthy subjects

This study aims to confirm the "vegetable-first" effect. In addition, because we aimed dietary fiber in vegetable salad, the effect after the ingestion of vegetable salad extract (vegetable salad from which solids have been removed) before carbohydrates on postprandial serum glucose level was also evaluated. A total of 13 healthy men were given meals after one-night of fasting: rice-vegetable salad, vegetable salad-rice, and vegetable salad extract-rice. Blood samples were taken at 0, 30, 45, 60, 90, and 120 min after the ingestion of the test meal to measure serum glucose levels. Serum glucose levels were significantly lower after 45 and 60 min in the vegetable salad-rice group compared to the rice-vegetable salad group. No significant difference was found between the vegetable salad extract-rice group and the vegetable salad-rice/rice-vegetable salad group. The result suggested that it might be important to ingest vegetables to obtain the "vegetable-first" effect.

Late relapsing testicular cancer detected with 18F-FDG PET preceded by long-term alpha-fetoprotein elevation

Late relapse (LR) of testicular cancer is often associated with chemoresistance, and thus the first choice of therapy is surgery if complete resection is possible. In some LR cases (including our patient, a 31-year-old Japanese man), elevation of alpha-fetoprotein (AFP) may precede the radiologic detection of LR. Approximately 500 days after the start of our patient's AFP elevation, 18F-fluordeoxyglucose positron emission tomography (FDG-PET) revealed strong FDG uptake in an equivocally enlarged external iliac lymph node. The lymphadenectomy as salvage surgery resulted in long-term complete remission without further treatment. Using FDG-PET made it possible to perform effective salvage surgery.

Effects of egg yolk choline intake on cognitive functions and plasma choline levels in healthy middle-aged and older Japanese: a randomized double-blinded placebo-controlled parallel-group study

BACKGROUND

Choline, as a neurotransmitter acetylcholine precursor, is reportedly associated with cognitive function. Although there are several cohort and animal studies on choline-containing foods and cognitive function, only a few interventional studies were reported. Egg yolk is a rich source of different choline-containing chemical forms, such as phosphatidylcholine (PC), lysophosphatidylcholine (LPC), and α-glycerophosphocholine (α-GPC). This study aimed to investigate the effect of consuming 300 mg of egg yolk choline per day on cognitive function of Japanese adults.

METHODS

A 12-week, randomized, double-blind, placebo-controlled, parallel-group study was conducted in 41 middle-aged and elderly males and females (43.9% female) aged ≥ 60 years and ≤ 80 years without dementia. Participants were randomly assigned to placebo and choline groups. The choline group received a supplement containing egg yolk choline (300 mg/day), and the placebo group received an egg yolk supplement free from choline for 12 weeks. Assessments of Cognitrax, Trail Making Tests (TMT) part A and B, the MOS 36-Item Short-Form Health Survey (SF-36), the Simplified Japanese Version of the WHO-Five Well-Being Index (WHO-5), and plasma choline levels were performed before and 6 and 12 weeks after supplement intake. In the present study, 19 subjects (9 in the placebo group and 10 in the choline group) were excluded due to the violation of the discontinuation criteria or participant compliance, and 41 subjects were analyzed.

RESULTS

The change amount of verbal memory scores and verbal memory test-correct hit (delay) was significantly higher in the choline group than in the placebo group at baseline-6 and baseline-12 weeks. The plasma free choline level was significantly higher in the choline group compared with the placebo group at 6 weeks. Conversely, the choline group showed significantly lower Cognitrax processing speed scores, symbol digit coding testing correct responses, and SF-36 physical quality of life summary scores compared to the placebo group at 6 weeks.

CONCLUSIONS

The results suggested that continued 300 mg/day intake of egg yolk choline improved verbal memory, which is a part of cognitive functions. To confirm the observed effects of egg yolk choline, more well-designed and large-scale studies are warranted.

TRIAL REGISTRATION

Study protocols were pre-registered in the Clinical Trials Registration System (UMIN-CTR) (UMIN 000045050).

Effects of temperature fluctuations on non-volatile taste compounds in tilapia fillets (Oreochromis niloticus)

In this study, the effect of temperature fluctuations on the taste quality of tilapia fillets during frozen storage was investigated. Major temperature-responsive factors included free amino acids (FAAs) and flavor nucleotides in fish fillets, which were identified using multidimensional infrared spectroscopy (MM-IR). The main FAA in tilapia fillets is a sweet amino acid (glycine). Compared with the control group, the umami FAAs and sweetness FAAs were significantly increased, and the total FAAs content increased to 1.30 times after the ninth fluctuation, reaching the highest level (611.16 ± 73.60 mg/100 g). Considering the equivalent umami intensity values, adenosine monophosphate and inosine monophosphate were retained during the first and second temperature fluctuations. In addition, the content of Na⁺, K⁺, and Ca²⁺ decreased (P < 0.05). Therefore, MM-IR is an effective method to identify taste components. With regard to taste quality, temperature fluctuations in the twofold range have an umami-enhancing effect.

Physical properties, chemical composition, and nutritional evaluation of common salad dressings

Salad dressings (SDs), a subcategory of flavored sauces with more than 20% fat content and less than 30% moisture content, is favored by consumers due to its delicacy. The physical properties, chemical composition and nutritional evaluation of common SDs on the Chinese market needs to be systematically investigated. This study compared the quality (physical properties, proximate composition, amino acids, fatty acids, and minerals) of six commercially available sweet SDs (SD1, SD2, SD3, SD4, SD5, and SD6) from the Chinese market. The results indicated that the water activity of six SDs was less than 0.60 (0.35–0.41), the moisture content was less than 65% (24.0–60.0%), and the crude fat content was between 23.25 and 64.15%. The essential amino acid index (EAAI) of SD3, SD1, SD2, and SD4 was greater than the FAO/WHO standard (EAAI = 75). Numerous fatty acids were detected, mainly linoleic and oleic acids; n-3 polyunsaturated fatty acids were ranged from 1,090 mg/100 g to 2,520 mg/100 g. In addition, SDs were rich in minerals such as Mg, Ca, and Fe and the atherogenic index and thrombogenic index were 0.03–0.09 and 0.77–0.91, respectively. In summary, this work helps to provide key nutritional information on the composition of common SDs. The availability of this data may help purchasers with different nutritional needs to make informed choices about the use of SD and encourage more moderate consumption of pre-packaged sauces.

Health Functions of Egg Protein

Egg protein is a remarkably abundant source of protein, with an amino acid score of 100 and the highest net protein utilization rate. However, there have been relatively fewer studies investigating the health benefits of egg protein. In this review, we have summarized the available information regarding the health benefits of egg proteins based on human studies. In particular, studies conducted on the characteristics of egg whites, as they are high in pure protein, have reported their various health functions, such as increases in muscle mass and strength enhancement, lowering of cholesterol, and visceral fat reduction. Moreover, to facilitate and encourage the use of egg white protein in future, we also discuss its health functions. These benefits were determined by developing an egg white hydrolysate and lactic-fermented egg whites, with the latter treatment simultaneously improving the egg flavor. The health benefits of the protein hydrolysates from the egg yolk (bone growth effect) and eggshell membrane (knee join pain-lowering effect) have been limited in animal studies. Therefore, the consumption of egg protein may contribute to the prevention of physical frailty and metabolic syndromes.

Effect of different drying methods on free amino acid and flavor nucleotides of scallop (patinopecten yessoensis) adductor muscle

The effects of hot air drying (HAD), vacuum hot air drying (VHAD), microwave drying (MWD), and vacuum freeze drying (VFD) on free amino acids (FAAs) and flavor nucleotides in scallop adductor muscle (SAM) were studied. The liquid chromatography and multidimensional infrared spectroscopy (MM-IR) were used. Compared with fresh SAM, the main FAAs were glycine, alanine, arginine, and glutamic acid in dried SAM. The total FAAs content in VFD group was 1.40-1.90 times of the other group. The umami taste nucleotides (IMP and AMP) content in the VFD and MWD groups was significantly higher than that in HAD and VHAD groups. Equivalent umami concentrations were found: VFD > MWD > VHAD > HAD. MM-IR analysis was an efficient method for identifying taste components. The results revealed FAAs and flavor nucleotides and the mutual adjustment of compounds were related to drying method, and VFD was preferred for taste substance retention in scallops.

The prognosis of endometrial cancers stratified with conventional risk factors and modified molecular classification

This study aimed to validate the Proactive Molecular Risk Classifier for Endometrial Cancer, a modified version of The Cancer Genome Atlas, using data from 184 patients with endometrial cancer (median age: 57.5 years; median follow‐up period: 109 months) who had undergone radical surgery (including systemic lymphadenectomy) and subsequent adjuvant chemotherapy (patients with intermediate or high recurrence risk) from 2003 to 2015. Tissue microarrays were prepared from surgical specimens and classified using the conventional clinical risk classifier. Immunohistochemistry was used to detect mismatch repair proteins, L1 cell adhesion molecule, and p53. Direct sequencing was used to identify hotspot mutations in the polymerase‐epsilon gene. Forty‐five patients were identified as having high L1 cell adhesion molecule expression, 41 as low risk, 34 as mismatch repair‐deficient, 13 as polymerase‐epsilon gene‐mutated, five as having abnormal p53, and 46 as other. Patients were stratified into significantly different prognostic groups (p < 0.0001): favorable (low risk and polymerase‐epsilon gene‐mutated), intermediate (mismatch repair‐deficient and other), and unfavorable (high L1 cell adhesion molecule expression and abnormal p53) with 5‐year disease‐specific survival rates of 100%, 93.8%, and 75.1%, respectively (Kaplan–Meier method). The combination of conventional recurrent risk classification, sequencing for polymerase‐epsilon gene mutations and immunohistochemistry for L1 cell adhesion molecule, p53, and mismatch repair proteins can be used to determine the prognoses of patients with endometrial cancer.

Property of Phytosterols and Development of Its Containing Mayonnaise-Type Dressing

Phytosterols are functional ingredients with known efficacy and safety. Phytosterols are found as free sterols or as their esters with fatty acids. Although phytosterol esters are soluble in oil and have been used in many commercial foods, it has been difficult to similarly use free phytosterols since they are insoluble in water and practically insoluble in oil. We have developed mayonnaise-type dressing materials using free phytosterols since people who are conscious about cholesterol intake are likely to be conscious about oil. In this review article, we summarized pieces of evidence for the development of phytosterol-containing mayonnaise-type dressing materials.

Comparison of Egg Yolk and Soybean Phospholipids on Hepatic Fatty Acid Profile and Liver Protection in Rats Fed a High-Fructose Diet

Perturbed lipid metabolism leads to ectopic lipid accumulation in tissues, such as the liver, thereby causing nonalcoholic fatty liver disease (NAFLD) and negatively influencing circulating lipid profile-inducing dyslipidemia. Phospholipids (PLs) with special biological activity are used to treat chronic diseases such as cardiovascular and cerebrovascular disease. PLs derived from egg yolk and soya bean have significant antioxidant and lipid-lowering abilities. This study examined the therapeutic effects of them on hyperlipidemia using a high-fructose-fed rat model; lipid metabolism and anti-inflammatory effects were also analyzed. The results showed that both egg yolk and soya bean phospholipids (EPLs and SPLs) reduced liver weight, hepatic TG, and MDA content as well as serum ALT, AST, TBA, and CRP levels (p < 0.05). The PLs also showed hypolipidemic and anti-inflammatory effects. EPLs and SPLs could inhibit the accumulation of hepatic fatty acids C18:1N9C, C18:0, and C22:6NS of rats fed a high-fat-and-sucrose diet. The intake of EPLs could significantly increase acetylcholine content in the blood and brain tissue. Histological examination showed that PLs intake could ameliorate the damage to liver tissue. This study suggested that EPLs and SPLs had a certain capacity of hypolipidemic and liver protection, and the therapeutic benefits of EPLs tended to be more effective than that of soybean phospholipids.

Nutritional Viewpoints on Eggs and Cholesterol

Although most current epidemiologic studies indicate no significant association between consuming one egg daily and blood cholesterol levels and cardiovascular risk, arguments still persist with a positive association. Since the diet is one of the most influential factors for this association, we illustrate characteristic features in Japanese people whose dietary pattern is distinct from that, for example, the US (United States) population. Available epidemiologic studies in healthy Japanese people show no association between consumption of one egg daily and blood cholesterol level, consistent with those observed in the US population. However, when consumption of major nutrients and food sources of cholesterol are compared to the US population, Japanese people may have an extra-reserve against the influence of eggs on cardiovascular risk markers, despite consuming relatively more eggs. Further discussion on the influence of nutrients contained in the egg and dietary pattern, including interaction with gut microbes, is necessary. In addition, special consideration at the personalized level is needed for judgment regarding dietary cholesterol not only for hypercholesterolemic patients but for hyper-responsive healthy persons. Although randomized controlled trials with long-term follow-up are required to evaluate the association between consumption of eggs and human health, available information, at least from the nutritional viewpoint, suggests that egg is a healthy and cost-efficient food worldwide.

Protective action of the microbial metabolite butyrate against cardiomyocyte hypertrophy

Introduction

Short-chain fatty acids are one of the gut microbial metabolites that may influence host physiology. We previously reported that gut dysbiosis was associated with heart failure, and that the proportions of butyrate-producing bacteria diminished prominently in the gut of patients with heart failure.

Purpose

We investigated the molecular mechanism of butyrate and investigated the protective mechanism against heart failure.

Methods

We searched for G protein-coupled receptors for short-chain fatty acids using single-cell transcriptome analysis of cardiomyocytes and non-cardiomyocytes isolated from murine hearts. In addition, we examined the effects of butyrate on endothelin-1 (ET1) or isoproterenol-induced hypertrophic responses and histone deacetylase (HDAC) activities in cultured neonatal rat cardiomyocytes.

Results

Single-cell transcriptome analysis and co-expression network analysis revealed that G protein-coupled receptors for short-chain fatty acid receptors were not expressed in cardiomyocytes and that Olfr78 was expressed in vascular smooth muscle cells in the heart. Treatment with butyrate inhibited ET1-induced hypertrophic growth and up-regulation of the genes such as Nppa, Acta1, and Myh7 in cultured rat neonatal cardiomyocytes. Moreover, butyrate increased the acetylation levels of histone H3, indicating that butyrate has an inhibitory effect on HDAC in cardiomyocytes. In addition, treatment with butyrate caused up-regulation of Inpp5f, encoding inositol polyphosphate-5-phosphatase f, which was associated with a significant decrease in the phosphorylation levels of Akt. These results suggest that butyrate may act as HDAC inhibitor to increase Inpp5f gene expression, leading to the activation of Akt-glycogen synthase kinase 3beta (Gsk3beta) pathway, and thereby protect against hypertrophic responses.

Conclusion

There was no known GPCR for short-chain fatty acid expressed in cardiomyocytes. However, butyrate suppressed cardiomyocyte hypertrophy through epigenetic modification of gene expression. Our results may uncover a potential role of the dysbiosis of intestinal microbiota in the pathogenesis of cardiac hypertrophy and failure.

Funding Acknowledgement

Type of funding source: None

Clinical impact of a cancer genomic profiling test using an in-house comprehensive targeted sequencing system

Precision medicine is a promising strategy for cancer treatment. In this study, we developed an in‐house clinical sequencing system to perform a comprehensive cancer genomic profiling test as a clinical examination and analyzed the utility of this system. Genomic DNA was extracted from tumor tissues and peripheral blood cells collected from 161 patients with different stages and types of cancer. A comprehensive targeted amplicon exome sequencing for 160 cancer‐related genes was performed using next‐generation sequencing (NGS). The sequencing data were analyzed using an original bioinformatics pipeline, and multiple cancer‐specific gene alterations were identified. The success rate of our test was 99% (160/161), while re‐biopsy was required for 24% (39/161) of the cases. Potentially actionable and actionable gene alterations were detected in 91% (145/160) and 46% (73/160) of the patients, respectively. The actionable gene alterations were frequently detected in PIK3CA (9%), ERBB2 (8%), and EGFR (4%). High tumor mutation burden (TMB) (≥10 mut/Mb) was observed in 12% (19/160) of the patients. The secondary findings in germline variants considered to be associated with hereditary tumors were detected in 9% (15/160) of the patients. Seventeen patients (11%, 17/160) were treated with genotype‐matched therapeutic agents, and the response rate was 47% (8/17). The median turnaround time for physicians was 20 days, and the median survival time after the initial visit was 8.7 months. The results of the present study prove the feasibility of implementing in‐house clinical sequencing as a promising laboratory examination technique for precision cancer medicine.

Low expression of gamma-glutamyl transpeptidase 1 is an independent poor prognostic factor in ovarian clear cell carcinoma, in relation to up-regulation of immune suppressive genes and EMT-related genes

6042

Background: Ovarian clear cell carcinoma (OCCC) is a distinct entity from other epithelial ovarian cancers such as the most prevalent high-grade serous cancer (HGSC), and often exhibit less sensitivity to platinum-based chemotherapy. Several studies using cell lines have reported that glutathione (GSH) metabolism plays an important role in chemo-resistance of OCCC. Here, we aimed to correlate the prognosis of OCCC and the expression of gamma-glutamyltransferase 1 (GGT1), one of the key enzymes in GSH metabolism. Methods: We prepared a FFPE-tissue microarray, and analyzed 56 OCCC patients with the follow-up periods over 3 years. Expression level of GGT1 was evaluated by immunohistochemistry (IHC) using H-score (0-300), and was correlated with clinical outcomes. The prognostic significance was assessed by multivariate analysis using Cox regression model. To investigate the possible related pathways, we performed transcriptome analysis using Ion AmpliSeq Transcriptome Human Gene Expression Kit (Thermo Fisher Scientific) from the frozen tissue specimens collected from 33 ovarian cancer patients including 15 OCCC patients and 18 HGSC patients. Results: The OCCC patients were divided into two populations in the histogram of H-score in IHC staining, and the cut-off value was 90; 44 cases showed GGT1-high, and remaining 12 cases were GGT1-low. Follow-up periods, FIGO stage, and optimal surgery rate were not significantly different between two groups. However, platinum-resistant recurrent rate was significantly higher (42% vs. 14%, p=0.027), and overall survival (OS) was significantly shorter (5-year OS; 42% vs. 72%, p=0.0226) in GGT1-low OCCC. Multivariate analysis revealed that low expression of GGT1 was one of the independent poor prognostic factors as well as platinum-drug resistance. In enrichment analysis, the genes related to GSH metabolism, such as SLC3A1, GGT1, CSE, and GPX3 were up-regulated and positively correlated with HNF1B expression in OCCC. The expression level of GGT1 was inversely correlated with that of immune suppressive genes (TGF-b, IFNG, IL10, FOXP3, PD-L1, CTLA4) and epithelial-mesenchymal transition (EMT)-related genes (CDH2, VIM, TWIST1, ZEB1, ZEB2) in OCCC samples. Conclusions: Low expression of GGT1 is an independent poor prognostic factor probably in part due to suppression of tumor immunity and induction of EMT in OCCC.

CD133 and epithelial cell adhesion molecule expressions in the cholangiocarcinoma component are prognostic factors for combined hepatocellular cholangiocarcinoma

AIM

A new classification of combined hepatocellular cholangiocarcinoma (CHC) was recently reported. Cancer stem cells have been associated with CHC carcinogenesis. This study examined the association of cancer stem cell marker expression and prognosis in CHC classified using the new classification.

METHODS

We enrolled 26 CHC patients and classified them according to the new classification. We evaluated the expression of cancer stem cell markers (CD56, CD133, and epithelial cell adhesion molecule [EpCAM]) by immunohistochemical staining in each component. We analyzed the association between expressions and prognosis.

RESULTS

Seven cases were hepatocellular carcinoma (HCC) and cholangiocarcinoma (CCA) (cHCC-CCA), 12 were HCC and intermediate cell carcinoma (HCC-INT), and seven were intermediate cell carcinoma (INT). The CD133-positive rate tended to be higher in the CCA (42.9%) and INT component (50.0%) than the HCC component (14.3%) in cHCC-CCA. In HCC-INT, the CD133-positive rate in the INT component (83.3%) was significantly higher than the HCC component (8.3%; P = 0.001). For EpCAM, the positive rate in the CCA component (71.4%) and INT component (50.0%) tended to be higher than the HCC component (14.3%) in cHCC-CCA. Overall survival and disease-free survival were significantly worse in cases with CD133-positive (P = 0.048 and P = 0.048, respectively) or EpCAM-positive (P = 0.041 and P = 0.041, respectively) CCA component in cHCC-CCA.

CONCLUSIONS

INT and CCA components showed higher expression rates of cancer stem cell markers than the HCC component. CD133 or EpCAM expression in the CCA component was associated with poor prognosis in cHCC-CCA.

L1CAM Predicts Adverse Outcomes in Patients with Endometrial Cancer Undergoing Full Lymphadenectomy and Adjuvant Chemotherapy

BACKGROUND

L1 cell adhesion molecule (L1CAM) has been established as an important predictor of poor survival of early-stage endometrial cancer patients. We investigated whether L1CAM remains a significant predictor of poor survival of patients with advanced-stage endometrial cancer undergoing extensive surgical staging and adjuvant chemotherapy.

METHODS

We prepared tissue microarray (TMA) from surgical tissue specimens of 161 endometrial cancer patients who underwent full lymphadenectomy combined with adjuvant chemotherapy for patients at risk for recurrence, and evaluated expression of L1CAM using immunohistochemistry. The correlation between L1CAM positivity and clinicopathological factors and the prognostic significance of L1CAM expression was investigated.

RESULTS

Among 161 cases who had a follow-up duration of over 3 years, 48 cases (29.8%) showed positive staining for L1CAM. L1CAM positivity was significantly correlated with non-endometrioid histology (p < 0.0001), vascular invasion (p = 0.0157), and positive cytology (p = 0.005), and was a significant predictor of poor survival among advanced-stage patients, but not early-stage patients in our cohort. L1CAM-positive patients showed a higher recurrence rate and frequency of distant failure than L1CAM-negative patients. Multivariate analysis revealed that para-aortic lymph node metastasis (PANM) and L1CAM positivity were independent predictors of poor survival. Overall survival can be stratified into three groups by the combination of PANM and L1CAM positivity.

CONCLUSION

L1CAM is an independent predictor of poor survival in endometrial cancer patients undergoing full lymphadenectomy and adjuvant chemotherapy, thus indicating that L1CAM can be clinically used as a biomarker to identify those patients at increased risk of recurrence.

Heated egg white has no effect, but lactic fermented and unheated egg white reduces abdominal fat in rats

Background

We previously reported the abdominal fat-reducing effect of unheated egg white proteins (EWP); however, unheated egg white is actually rarely consumed. We thus investigated the effect of heated egg white on abdominal fat in rats.

Methods

Male SD rats were divided into two groups that were allowed to consume different dietary preparations containing casein or heated egg white for 4 weeks (Trial 1). We studied whether a heated form and a lactic fermented form of egg white (FLE) are as effective as unheated egg white for reducing abdominal fat. For this, we divided male SD rats into four groups that were allowed to consume different dietary preparations containing casein, unheated egg white, heated egg white, or lactic fermented egg white for 4 weeks (Trial 2).

Results

Animals in the heated egg white group showed no significant difference in abdominal fat weight compared with those in the casein group (Trial 1). Animals in the unheated egg white group and the FLE group had significantly lower levels of abdominal fat weight than those in the casein group (Trial 2). Ovalbumin in heated egg white was degraded by pepsin, whereas ovalbumin in unheated egg white and lactic acid fermented egg white was not degraded appreciably by pepsin. It was reported that EWP inhibit triglyceride absorption in rat. In the present study, EWP pepsin hydrolysate inhibited the micellar solubility of fatty acids in vitro. In particular, ovalbumin inhibited the micellar solubility of fatty acids.

Conclusions

These results indicate that lactic fermented egg white reduces visceral fat in rats and suggest that different levels of susceptibility of ovalbumin to pepsin digestion underlie the varying effectiveness among the egg white preparations.

Topical hyaluronan alone promotes corneal epithelial cell migration whereas combination with benzalkonium chloride impairs epithelial wound healing

Purpose: To evaluate the effects of topical hyaluronan (HA) on corneal epithelial wound healing when administered with or without benzalkonium chloride (BAC).Methods: A cultured human corneal epithelial cell line (HCE-T) was subjected to in vitro scratch assays and in situ epithelial migration was evaluated in organ-cultured rabbit corneas. The corneal epithelium of C57BL/6J mice was also evaluated to determine in vivo wound healing. An in vivo imaging system was also used to evaluate the effects of HA on eye drop retention on the ocular surface.Results: The findings revealed the promotion of HCE-T migration, in situ rabbit corneal epithelial migration, and in vivo wound healing in mouse corneal epithelium by HA. Pre-treatment with HA also protected against delayed epithelial wound healing in BAC in vitro. However, pre-treatment with 3 mg/mL HA did not show a protective effect against BAC in vivo, but instead delayed epithelial wound healing and increased detection of cleaved caspase-3. This suggested that HA promotes the retention of BAC on the ocular surface. The instilled HA was retained after 15 min, at a significantly higher rate than for phosphate-buffered saline.Conclusions: The combination of HA and BAC impaired wound healing in the corneal epithelium.

Laparoscopic subtotal colectomy for a patient with chronic idiopathic colonic pseudo-obstruction: Report of a case

A 47-year-old male patient without a documented past medical history was referred to Sanno Hospital because of constipation and abdominal pain, which he had had for more than 5 years. Abdominal X-ray and CT scan showed an enlarged ascending colon from the cecum to the transverse colon, without apparent mechanical obstruction. The patient was diagnosed with chronic idiopathic colonic pseudo-obstruction, and because his symptoms were resistant to medication, surgical treatment was required. Laparoscopic subtotal colectomy was performed without any complications. Constipation was relieved, and the patient began defecating 2-3 times a day without medication. Pathological specimens showed that Meissner's plexus and Auerbach's plexus had decreased and that there were fewer ganglion cells-findings consistent with chronic idiopathic intestinal pseudo-obstruction.

Treatment of twin-reversed arterial perfusion sequence using high-intensity focused ultrasound

We describe our experience of high-intensity focused ultrasound (HIFU) for fetal therapy in twin-reversed arterial perfusion (TRAP) sequence. Six pregnant women underwent HIFU therapy, five before 16 weeks and one at 26 weeks. Two types of HIFU system were used: the first-generation system, which comprised a biaxial transducer and continuous exposure pattern, and the second-generation system, which comprised a coaxial transducer and sequential exposure pattern. The first-generation apparatus was used in four cases and the second-generation apparatus was used in two. In three cases, occlusion of the blood vessels mediating flow to the acardiac twin was achieved by HIFU. Two cases experienced intrauterine fetal death despite vessel occlusion. The total survival rate of pump fetuses 2 years after HIFU was 67% and the efficiency rate (the proportion of cases with occlusion or reduced blood flow on ultrasound after HIFU) was 83%. After more than 2 years of follow-up, the surviving infants had no severe clinical complications and no postnatal developmental problems. There was no significant difference in survival rate compared with TRAP cases managed expectantly. Given that complete occlusion of the blood vessels was not achieved in half of the cases, we could not show that HIFU therapy is superior to other treatments. However, HIFU can reduce the cardiac load of the pump fetus and, as it does not require uterine puncture for fetal therapy, there were no fatal complications, such as bleeding, rupture of membranes or infection. Thus, HIFU therapy may represent a less-invasive treatment for TRAP sequence in early pregnancy. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.

Abstract 4020: Correlation between the expression of glutathione metabolism-related genes and prognosis in ovarian clear cell carcinoma

Background: Ovarian clear cell carcinoma (OCCC) is more prevalent in Japan than western countries, exhibits chemoresistant phenotype and poor survival. Although the expression of the genes related to glutathione (GSH) metabolism had been reported as one of the possible chemoresistant mechanisms, correlation between the expressions of these genes and prognosis in OCCC patients remains unclear. In this study, we aim to investigate 1) enrichment pathway analysis in OCCC in comparison with high-grade serous carcinoma (HGSC), and 2) correlation between the expression of gamma-glutamyl transpeptidase 1 (GGT1), one of the enzymes in GSH metabolism and prognosis.

Methods: We consecutively collected surgically resected tissue specimens from 33 ovarian cancer patients; 15 patients with OCCC and 18 patients with HGSC. The tissue specimens were collected in the vials containing RNA later® within 10 min. after resection of tumors. Total RNAs were extracted from the tumor tissues, and comprehensive gene expression analysis was performed using Ion AmpliSeq™ Transcriptome Human Gene Expression Kit (Thermo Fisher Scientific). For prognostic analysis, we used a tissue microarray (TMA) from 56 consecutive patients pathologically diagnosed with OCCC in our hospital, and assessed by immunohistochemistry (IHC) using H-score ranging from 0 to 300. Overall survival (OS) was estimated by Kaplan-Meier method, and analyzed by Cox-regression hazard model in multivariate analysis.

Results: Gene expression profiles revealed that TCF1/2 target genes were up-regulated in OCCC samples in comparison with HGSC. In addition, genes related with amino-acid transporters, such as SLC3A1, a cystine transporter, and genes related to GSH metabolism, including GGT1, CSE, and GPX3 were also up-regulated. In the OCCC patients with high expression level of GSH-related genes, FOXP3 was down-regulated but the T-cell inflamed genes were not varied compared to the OCCC patients with low expression level. The expression level of GGT1 in gene expression analysis was strongly correlated with H-score of GGT1 in IHC (r = 0.7850, p = 0.0023). In prognostic analysis, there were no significant differences during follow up period (57.5 months vs. 53 months), FIGO stage (I: 50% vs 64%), optimal surgery (92% vs. 98%), or recurrent rate (42% vs. 30%) between GGT1 positive (n = 44) and negative (n = 12) OCCC in IHC. However, platinum-drug resistant recurrent rate was significantly higher in GGT1 negative OCCC than GGT1 positive OCCC (42% vs 14%, p = 0.027). OS in GGT1 negative OCCC was significantly worse than that of GGT1 positive OCCC (5-year OS was 42% vs 72%, p = 0.0226), and negative expression of GGT1 was one of the independent poor prognostic factors in OCCC.

Conclusion: Negative expression of GGT1 in OCCC might be a poor prognostic maker via recruitment of regulatory T cells in tumor microenvironments.

Citation Format: Hiroshi Asano, Ryosuke Matsuoka, Kanako C. Hatanaka, Yutaka Hatanaka, Tatsuya Kato, Yosuke Konno, Takashi Mitamura, Hirotoshi Akita, Yoshihiro Matsuno, Hidemichi Watari. Correlation between the expression of glutathione metabolism-related genes and prognosis in ovarian clear cell carcinoma [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 4020.

Eggshell membrane protein can be absorbed and utilised in the bodies of rats

Objective

Eggshell membranes, the thin film lining the insides of eggshells, are constituted mostly from protein (eggshell membrane protein, ESM-P). The digestibility and dietary net protein utility of ESM-P are not known. ESM-P functions as a barrier to prevent foreign matter from reaching the egg white and yolk, so it would be expected not to decompose easily by digestion when ingested. We therefore prepared a hydrolysate of the membrane (ESM-H). In this study, we assessed the digestibility and net protein utility of ESM-P and ESM-H in rats.

Results

The digestibility of ESM-P and ESM-H were 87.0% and 94.8%, respectively, significantly lower than that of casein (98.5%). The net protein utility values were 84.7% and 84.6%, respectively, significantly higher than that of casein (75.1%). Digestibility was significantly higher for ESM-H than for ESM-P, but there was no significant difference in net protein utility between ESM-P and ESM-H. These results demonstrated that more than 80% of ESM-P or ESM-H is absorbed and utilised in the bodies of rats.

Minimal effective dose of lactic-fermented egg white on visceral fat in Japanese men: a double-blind parallel-armed pilot study

Background

We previously reported that the consumption of 8 g of protein per day in the form of lactic-fermented egg white (LAFEW) improves visceral fat obesity. In this study, we investigated the minimum effective intake of LAFEW for visceral fat reduction in the Japanese males with mild obesity.

Methods

Twenty-two Japanese adult males with a Body mass index (BMI) ≥24 and a waist circumference ≥ 85 cm were included in this study. The subjects were divided into three groups, that is, control group, LAFEW 6 g group, and LAFEW 8 g group. The LAFEW 6 and 8 g groups consumed 6 and 8 g, respectively, of egg white protein (EWP) in a drink at breakfast for 8 weeks, whereas the control group consumed a drink containing 8 g of milk whey protein. Body weight, body fat percentage, abdominal circumference, and visceral fat (VF) area around the navel were measured at 0 and 8 weeks after initiating the consumption.

Results

No changes in body weight or body fat percentage were observed in any of the groups. No significant differences between the pre- and posttreatment measurements were found in the VF area around the navel in the control group and the LAFEW 6 g group. In the LAFEW 8 g group, the VF area had decreased significantly after 8 weeks of consumption, when compared to that before consumption, and the average observed decrease (Δcm²) was 13.2 ± 4.7 cm². Among the subjects with an initial BMI > 25, the VF area was significantly smaller in the LAFEW 8 group, when compared to the week 0 values and those in the control group. Visceral fat/subcutaneous fat values in the LAFEW 8 group were also significantly smaller than those in the control group or at week 0.

Conclusion

The results suggested that the minimum effective intake of EWP in the LAFEW to reduce the VF area in the Japanese men is 8 g.

Trial registration

This clinical trial was retrospectively registered with the University hospital Medical Information Network (UMIN) Center, (UMIN000031681; registered on 12/03/2018).

Impaired mitochondrial oxidative phosphorylation capacity in epicardial adipose tissue is associated with decreased concentration of adiponectin and severity of coronary atherosclerosis

Epicardial adipose tissue (EAT), a source of adipokines, is metabolically active, but the role of EAT mitochondria in coronary artery disease (CAD) has not been established. We investigated the association between EAT mitochondrial respiratory capacity, adiponectin concentration in the EAT, and coronary atherosclerosis. EAT samples were obtained from 25 patients who underwent elective cardiac surgery. Based on the coronary angiographycal findings, the patients were divided into two groups; coronary artery disease (CAD; n = 14) and non-CAD (n = 11) groups. The mitochondrial respiratory capacities including oxidative phosphorylation (OXPHOS) capacity with non-fatty acid (complex I and complex I + II-linked) substrates and fatty acids in the EAT were significantly lowered in CAD patients. The EAT mitochondrial OXPHOS capacities had a close and inverse correlation with the severity of coronary artery stenosis evaluated by the Gensini score. Intriguingly, the protein level of adiponectin, an anti-atherogenic adipokine, in the EAT was significantly reduced in CAD patients, and it was positively correlated with the mitochondrial OXPHOS capacities in the EAT and inversely correlated with the Gensini score. Our study showed that impaired mitochondrial OXPHOS capacity in the EAT was closely linked to decreased concentration of adiponectin in the EAT and severity of coronary atherosclerosis.

Egg white hydrolysate improves fatigue due to short-term swimming load test in mice

We studied the effect of egg white hydrolysate (EWH) on swimming endurance in mice. 7-week-old male ddY mice (28-30 g) were divided into three groups and fed an AIN-93G diet supplemented with casein (n = 8), EWH (n = 7), or egg white protein (EWP, n = 8) for 14 days. From day 11, the mice underwent a swimming test daily with a weight load equivalent to 10% of their body weight, and the lengths of time they swam were recorded. Blood was sampled for testing on the last day of the study. We observed that increases in the swimming duration through day 14 were significantly greater in the EWH group than in the casein group (p = 0.049). As a factor underlying this, the hexanoyl-lysine level in blood was confirmed to be decreased in the former group (p = 0.013). These findings indicate that consumption of EWH extended the swimming duration and suggest the mechanistic involvement of an antifatigue effect mediated by its antioxidant activity.

Glomangiopericytoma of the Nasal Cavity with CTNNB1 p.S37C Mutation: A Case Report and Literature Review

Glomangiopericytoma (GPC) is a rare mesenchymal tumor arising from the nasal cavity or paranasal sinuses. GPC was categorized as a borderline and low-malignant-potential tumor by the World Health Organization in 2005 and accounts for less than 0.5% of all sinonasal tumors. We report a case of GPC in a 74-year-old woman with a history of recurrent epistaxis and nasal obstruction. A reddish tumor was seen in the right nasal cavity. Enhanced computed tomography showed a mass lesion occupying the right nasal cavity. The tumor, which originated from the nasal septum in the olfactory fissure area, was resected with 5-mm mucosal margins by endoscopic sinus surgery. Histologic examination revealed a uniform proliferation of oval-to-short spindle-shaped cells beneath the epithelium. Immunohistologic analysis demonstrated the tumor cells were positive for α-smooth muscle actin, β-catenin and Vimentin, and negative for AE1/AE3, Bcl-2, CD34, CD117, Factor VIIIR Ag, S-100 protein, or STAT6. The percentage of Ki-67-positive cells was approximately 5%. Genetic analysis using next-generation sequencing revealed a missense mutation in the CTNNB1 gene (c.110C > G, p.S37C). While other CTNNB1 mutations have been described in GPC; this is the first report of this specific mutation. The mutation was confirmed using Sanger sequencing.

Genomic testing for pancreatic cancer in clinical practice as real-world evidence

BACKGROUND

Precision medicine guided by comprehensive genome sequencing represents a potential treatment strategy for pancreatic cancer. However, clinical sequencing for pancreatic cancer entails several practical difficulties. We have launched an in-house clinical sequencing system and started genomic testing for patients with cancer in clinical practice. We have analyzed the clinical utility of this system in pancreatic cancer.

METHODS

We retrospectively reviewed 20 patients with pancreatic cancer who visited our division. Genomic DNA was extracted from both tumor tissue and peripheral blood mononuclear cells obtained from the patients. We performed a comprehensive genomic testing using targeted amplicon sequencing for 160 cancer-related genes. The primary endpoints were the detection rates of potential actionable and druggable gene alterations. The secondary endpoints were the detection rate of secondary germline findings, the rate of re-biopsy required for genome sequencing, survival time after the initial visit (post-sequencing survival time), and turnaround time.

RESULTS

Although re-biopsy was required for 25% (5/20) of all patients, genomic testing was performed in all patients. Actionable and druggable gene alterations were detected in 100% (20/20) and 35% (7/20) of patients, respectively, whereas secondary germline findings were detected in 5% (1/20) of patients. The median turnaround times for physicians and patients were 20 and 26 days, respectively. The median post-sequencing survival time was 10.3 months. Only 10% (2/20) of all patients were treated with therapeutic agents based on the outcomes of genomic testing.

CONCLUSIONS

The clinical application of comprehensive genomic testing for pancreatic cancer was feasible and promising in clinical practice.

Clinical implementation of a comprehensive targeted amplicon sequencing system for the patients with gastrointestinal cancer as a real world evidence in Japan

329

Background: Clinical implementation of genome sequencing is recently prevailing in the treatment for cancer. We have launched an in-house clinical sequencing system to perform exhaustive targeted exome sequencing for patients with all types of cancer, as an outpatient service. We have analyzed the clinical utility of this system for patients with gastrointestinal cancer to elucidate real world evidence. Methods: Genomic DNA was extracted from tumor tissues and peripheral blood sera of 86 patients with different types of gastrointestinal cancer, from April 2016 to April 2017. The top five types of primary cancer were colorectal (34%), pancreas (28%), stomach (13%), biliary tract (12%), and esophagus (8%). We performed a targeted amplicon exome sequencing for 160 cancer-related genes. The sequencing data was analyzed using an original bioinformatics pipeline within three days, and we identified cancer-specific somatic gene alterations such as SNV (Single Nucleotide Variation), Ins (Insertion)/Del (Deletion), and CNV (Copy Number Variation). The primary endpoints were the detection rates of potential actionable and druggable genes. The secondary endpoints were the detection rates of incidental germline variants and the period from initial visit to elucidation of the results to the patients. Results: Actionable and druggable gene alterations were detected in 97% (83/86) and 65% (56/86) of the subjects, respectively. Actionable gene alterations were frequently detected in TP53 (64/86), KRAS (38/86), APC (25/86), ARID1A (11/86), and FBXW7 (10/86). Druggable gene alterations were detected in ARID1A (11/86), and FBXW7 (10/86), BRAF (7/86), BRCA1/2 (6/86), and EGFR (4/86). Incidental germline variants were detected only in 6% (5/86) of all the patients. The median period of examination was 30 days (10-78 days). Seven out of the 86 patients (8%) were treated with therapeutic agents, based on the results of our clinical sequencing. Conclusions: Our clinical sequencing system provided a large number of cancer patients with clinically valuable genomic information available in selecting anticancer drugs within about a month.

Lactic-fermented egg white improves visceral fat obesity in Japanese subjects-double-blind, placebo-controlled study

BACKGROUND

It was reported that egg white protein (EWP) reduced body fat in rats. We developed a lactic-fermented egg white (LE) that facilitates the consumption of egg whites by fermenting them with lactobacillus, and were able to study their intake in humans. In this double-blind, placebo-controlled design, we evaluated the effect of LE on visceral fat area (VFA).

METHODS

Participants included 37 adult males and females aged ≥40 years (VFA at navel ≥100 cm²). They were divided into two groups: the control group and the LE group. The control and LE groups consumed drinks containing whey and LE, respectively, for 12 weeks (providing 8 g protein/day). VFA was measured at baseline and at week 12 of intake. Abdominal girth was measured at baseline and at weeks 6 and 12.

RESULTS

LE intake decreased VFA significantly compared with baseline (-8.89 cm², p < 0.05), and VFA was significantly lower than that in the control group (+1.71 cm², p < 0.05). The LE group showed significant improvement in the ratio of visceral to subcutaneous fat area compared with baseline and the control group (p < 0.05).

CONCLUSIONS

The results demonstrated that LE reduces VFA and improves the ratio of visceral to subcutaneous fat area. As other measurement items were not influenced, we concluded that LE improves visceral fat obesity.

TRIAL REGISTRATION

This clinical trial was retrospectively registered with the University hospital Medical Information Network (UMIN) Center, ( UMIN000026949 ; registered on 11/04/2017; http://www.umin.ac.jp /).

Multiple small hemorrhagic infarcts in cerebral air embolism: a case report

Background

Cerebral air embolism is a rare cause of cerebral infarction. In cerebral air embolism, T2 star-weighted imaging shows numerous spotty hypointense signals. Previous reports have suggested that these signals represent air in the brain and are gradually diminished and absorbed. We experienced two cases of cerebral air embolism, and in one of them, we conducted an autopsy.

Case presentation

Case 1 was a 76-year-old Japanese man with lung cancer and emphysema. A spasmodic cough induced massive cerebral and cardiac air embolisms and the patient died because of cerebral herniation. T2 star-weighted imaging of brain magnetic resonance imaging showed multiple spotty low signals. Brain autopsy showed numerous spotty hemorrhagic infarcts in the area of T2 star-weighted imaging signals. Case 2 was an 85-year-old Japanese man with emphysema who suffered from acute stroke. Similar spotty T2 star-weighted imaging signals were observed and remained unchanged 2 months after the onset.

Conclusions

These findings indicate that T2 star-weighted imaging in cerebral air embolism partially represents micro-hemorrhagic infarction caused by air bubbles that have migrated into the brain.

Maintaining good miRNAs in the body keeps the doctor away?: Perspectives on the relationship between food-derived natural products and microRNAs in relation to exosomes/extracellular vesicles

During the last decade, it has been uncovered that microRNAs (miRNAs), a class of small non-coding RNAs, are related to many diseases including cancers. With an increase in reports describing the dysregulation of miRNAs in various tumor types, it has become abundantly clear that miRNAs play significant roles in the formation and progression of cancers. Intriguingly, miRNAs are present in body fluids because they are packed in exosomes/extracellular vesicles and released from all types of cells. The miRNAs in the fluids are measured in a relatively simple way and the profile of miRNAs is likely to be an indicator of health condition. In recent years, various studies have demonstrated that some naturally occurring compounds can control tumor-suppressive and oncogenic miRNAs in a positive manner, suggesting that food-derived compounds could maintain the expression levels of miRNAs and help maintain good health. Therefore, our daily food and compounds in food are of great interest. In addition, exogenous diet-derived miRNAs have been indicated to function in the regulation of target mammalian transcripts in the body. These findings highlight the possibility of diet for good health through the regulation of miRNAs, and we also discuss the perspective of food application and health promotion.