Successful Systemic Steroid Administration for the Treatment of Edematous Anastomotic Stenosis After the Laparoscopic Augmented Rectangle Technique for Billroth I Reconstruction for Laparoscopic Distal Gastrectomy

Edematous anastomotic stenosis is a well-known complication following Billroth I anastomosis for distal gastrectomy. Currently, there is no established treatment for this condition. A 54-year-old female patient underwent the augmented rectangle technique for Billroth I reconstruction after total laparoscopic distal gastrectomy for early gastric cancer. On postoperative day (POD) 9, the patient started vomiting. During the conservative waiting period, edematous anastomotic stenosis was diagnosed using imaging on PODs 11 and 13. Systemic steroid administration was initiated on POD 13, and the drainage volume of the nasogastric tube decreased four days after initiation. The edematous anastomosis stenosis improved, and gastrografin flowed into the duodenum on POD 19. Food intake was started on POD 20. Oral steroid administration was continued after hospital discharge and gradually terminated. Systemic steroid treatment may help improve edematous anastomotic stenosis.

Transient Trabecular Formation in the Bladder and Delayed Free Air due to Traumatic Intraperitoneal Bladder Rupture

An H-section steel bar that had been set against the wall fell and hit the abdomen and then both legs of a 33-year-old Chinese man. As his vital signs were stable and his chief complaint was leg pain, he was transferred to a local medical facility. After the confirmation of gross hematuria by an indwelling a bladder catheter there, he was transported to our hospital. On arrival, his vital signs were stable. His main complaint was foot pain. He had a scabbing injury at the scrotum and bilateral foot joint deformity. Whole-body computed tomography (CT) from head to toe revealed trabecular formation in the bladder and slight fluid collection in the rectovesical pouch, as well as bilateral fracture-dislocations at the ankles. The urinary tract injury and the fluid collection in the rectovesical pouch were managed conservatively, and the lower limbs were treated tentatively. Follow-up CT on day 3 revealed multiple free air pockets in the intra-abdominal cavity, which was considered to indicate perforation of the duodenal ulcer and treated conservatively. However, he showed abdominal pain on day 7, and repeated CT revealed increased fluid in the intra-abdominal cavity. Urgent laparoscopy showed intact bowels and perforation of the bladder that was closed by suturing. He ultimately obtained a survival outcome. This is the first case of transient trabecular formation in the bladder and delayed free air due to traumatic intraperitoneal bladder rupture. This unique case adds another radiological finding to the list of documented etiologies of traumatic bladder perforation.

Overcoming the ceiling effects of experts' motor expertise through active haptic training

One of the most challenging issues among experts is how to improve motor skills that have already been highly trained. Recent studies have proposed importance of both genetic predisposition and accumulated amount of practice for standing at the top of fields of sports and performing arts. In contrast to the two factors, what is unexplored is how one practices impacts on experts' expertise. Here, we show that training of active somatosensory function (active haptic training) enhances precise force control in the keystrokes and somatosensory functions specifically of expert pianists, but not of untrained individuals. By contrast, training that merely repeats the task with provision of error feedback, which is a typical training method, failed to improve the force control in the experts, but not in the untrained. These findings provide evidence that the limit of highly trained motor skills could be overcome by optimizing training methods.

Non-tuberculosis cold abscess

An 85-year-old cachectic man was found unconscious in his home. He had no specific medical history. On arrival, he was in a deep coma and hypothermic state. He had a soft mass the size of his fist in the right lower abdomen without redness or heat. Truncal computed tomography revealed subcutaneous fluid collection with gas formation. A test puncture for right lower abdominal subcutaneous fluid collection revealed pus, so an open incision was performed, with the administration of broad-spectrum antibiotics. Unfortunately, the patient died of sepsis-induced multiple organ failure. The results of abscess culture later revealed Proteus mirabilis, Escherichia coli, and Prevotella melaninogenica. This is the first report of a cold abscess induced by mixed bacteria.

Pacemaker-associated infection caused by ST81/SCCmec IV methicillin-resistant, vancomycin-intermediate Staphylococcus aureus in Japan

A 76-year-old Japanese man was admitted to hospital for treatment of fever and skin lesion at the implantation site of his pacemaker. During his hospitalization, vancomycin-intermediate Staphylococcus aureus (MIC 4 μg/mL) with reduced susceptibility to daptomycin was isolated from venous blood. This isolate was identified as methicillin-resistant S. aureus with SCCmec IV and was genotyped as sequence type 81, coa VIIa and spa type t7044, harbouring blaZ, aac(6′)-aph(2″) and enterotoxin(-like) genes sea, seb, sek, sel, selx and selw. The patient was successfully treated with daptomycin, minocycline and sulfamethoxazole/trimethoprim. We describe the identification of sequence type 81/SCCmec IV vancomycin-intermediate S. aureus from pacemaker-associated septicaemia.

Analysis of the methylation of CpG islands in the CDO1, TAC1 and CHFR genes in pancreatic ductal cancer

No difference in the gene methylation status of tumor-suppression genes between pancreatic cancer tissues and adjacent non-cancer tissues is observed. The present study investigated whether the promoter CpG islands of the cysteine dioxygenase 1 (CDO1), tachykinin precursor 1 (TAC1) and checkpoint with forkhead and ring finger domains (CHFR) genes were methylated in pancreatic cancer and adjacent non-cancerous pancreatic tissue in order to determine if they could be considered as markers for the detection of pancreatic cancer. A total of 38 Formalin-fixed and paraffin-embedded pancreatic adenocarcinoma tissues and their adjacent non-cancerous specimens from patients with pancreatic cancer, as well as 9 non-cancerous pancreatic samples from patients without pancreatic adenocarcinoma were obtained following surgical resection. The hypermethylation of CpG islands was detected using a methylation-specific quantitative PCR. The methylation values were calculated using the ∆Cq method and were expressed as 2^−ΔCq. The 2^−ΔCq value of the CDO1 promoter from pancreatic adenocarcinoma specimens was significantly higher compared with that of adjacent non-cancerous and tumor-free pancreatic tissues (P<0.0001 and P=0.0008, respectively). The 2^−ΔCq value of the TAC1 promoter of pancreatic adenocarcinoma was also significantly higher compared with that of adjacent non-cancerous tissues and tumor-free pancreatic samples (both P<0.0001). However, there was no significant difference in the 2^−ΔCq value of the CHFR promoter among the pancreatic cancer, adjacent non-cancer tissue and tumor-free pancreatic samples. Furthermore, 12 out of the 38 pancreatic adenocarcinoma cases (31.6%) presented some methylation in the CHFR promoter. The results from Kaplan-Meier analysis between CHFR promoter methylation values and the clinicopathological characteristics of patients with pancreatic adenocarcinoma demonstrated that CHFR promoter methylation was significantly associated with lymph node metastasis. The methylation values of CDO1 and TAC1 promoters in cancer tissues were higher compared with adjacent tissues. However, whether hypermethylation of CDO1 and TAC1 promoters may serve as a biomarker in the diagnosis of pancreatic adenocarcinoma remains unclear.

Group A Streptococcal Toxic Shock-Like Syndrome in a Male Presenting as Primary Peritonitis: A Case Report and a Review in Japan

BACKGROUND

Streptococcal toxic shock-like syndrome (TSLS) is a severe infection caused by group A hemolytic streptococcus. It is clinically characterized by rapidly progressive septic shock and multiple organ failure within just a few hours. TSLS presenting as primary peritonitis is rare, especially in a male. Herein, we report a case of TSLS in a male presenting with primary peritonitis, with a review of 25 cases in Japan.

CASE PRESENTATION

A 51-year-old male was referred to our hospital with abdominal pain and hypotension. We made a preoperative diagnosis of peritonitis with septic shock and performed an emergency operation. Intraoperative findings indicated no marked origin of the peritonitis. Preoperative blood culture showed the presence of group A hemolytic streptococcus. The patient required intensive care involving artificial respiration, abdominal drainage and cytokine absorption therapy, and was discharged on postoperative day 25.

CONCLUSION

TSLS in a male presenting as primary peritonitis is rare. Although this condition is a severe infection, it can be treated by multimodal therapy.

Detection of gene mutations in gastric cancer tissues using a commercial sequencing panel

Predicting malignancy is important for adequate adjuvant therapy in patients with cancer. Due to cancer being a genetic disease, the detection of gene mutations could be helpful in predicting the prognosis and efficacy of drugs. Gastric cancer is the fifth most common cancer and is the third leading cause of cancer associated mortality worldwide. Mutations in genes may correlate with clinical information in patients with gastric cancer after surgery and, therefore, may be useful for predicting the prognosis of this disease. In the present study, to assess the usefulness of a commercial sequencing panel, TruSeq^® Amplicon-Cancer Panel (Illumina), using a next-generation sequencer (Illumina MiSeq), mutation analysis of fresh as well as formalin-fixed paraffin-embedded (FFPE) gastric cancer tissues was performed retrospectively. The study group comprised of 4 patients who underwent gastrectomy for gastric cancer. Cancer and normal stomach tissues were collected immediately following surgical removal. Thereafter, the specimens were fixed in 10% neutral formalin for 24–72 h. Normal and FFPE cancer tissues were histologically examined and confirmed. A total of 3 mutations were identified in the driver genes (KRAS, TP53 and APC) in cancer tissues from 2 of the 4 patients, using fresh samples. In addition, FFPE samples were analysed for the same tissues and the same results were obtained by setting the threshold for the percentage of the mutation rate to avoid detection of pseudo-positive mutations. In conclusion, the sequencing analysis using FFPE-derived DNA samples was successfully performed.

Impact of Left Colonic Artery Preservation on Anastomotic Leakage in Laparoscopic Sigmoid Resection and Anterior Resection for Sigmoid and Rectosigmoid Colon Cancer

OBJECTIVES

To investigate the effect of left colonic artery (LCA) preservation on laparoscopic sigmoidectomy outcomes METHODS: We identified 447 consecutive patients who underwent laparoscopic sigmoidectomy at our hospital group between January 2010 and December 2016. We divided the patients into groups with and without LCA preservation and with and without anastomotic leakage (AL). We compared the patient age and gender, tumor location, stage, D2/D3 lymph node dissection, comorbidities, operating time, and blood loss between these groups. Univariate and multivariate analyses were performed to determine the risk factors for AL.

RESULTS

There were significant differences in age, sex, tumor location, D2/D3 lymph node dissection, hypertension, operating time, blood loss, and AL for groups with and without LCA preservation. There were significant differences in sex, tumor location, and LCA preservation for groups with and without AL. Multivariate analysis showed male sex (hazard ratio (HR) = 6.37, 95% confidence interval (CI) 2.39-20.6; p < 0.0001), non-LCA preservation (HR = 5.01, 95% CI 1.41-31.8.0; p = 0.01), and rectosigmoidal tumor location (HR = 2.51, 95% CI 1.15-5.61; p = 0.01) as significant independent risk factors for AL.

CONCLUSIONS

Based on the results obtained by performing laparoscopic operation for sigmoid colon cancer and rectosigmoid cancer, the LCA preservative procedure is warranted for prevention of AL.

Abdominoperineal Resection for Unexpected Distal Intramural Spreading of Rectal Cancer

Introduction

In rectal cancer, distal intramural spread may sometimes occur, but a maximum extent of distal spread of > 6 cm is very rare.

Case Presentation

A 65-year-old Japanese male with an advanced rectal cancer tumor with para-aortic lymph node metastasis was admitted. We performed a low anterior resection with lymphadenectomy, but the intraoperative frozen-section analysis of margins revealed malignant cell positivity; we, therefore, performed an abdominoperineal resection. Pathological findings showed that the maximum extent of distal spread was 6 cm. After 12 courses of FOLFOX4 as adjuvant chemotherapy, abdominal computed tomography revealed whole lymph node metastases, including Virchow's node. Though FOLFIRI + panitumumab was started, he was not eligible for additional chemotherapy after 10 cycles.

Conclusion

An intraoperative frozen pathology examination was helpful for the additional resection, when unexpected distal spreading had occurred in rectal cancer. The evidence of a distal negative margin should not be underestimated.

Mixed Neuroendocrine Carcinoma and Squamous Cell Carcinoma of the Colon: Case Report and Literature Review

Neuroendocrine carcinoma (NEC) of the colon is very rare, and squamous cell carcinoma (SCC) of colon cancer is rare. We recently treated a patient with both NEC and SCC that initially presented as multiple unresectable liver and lung metastases. A 68-year-old Japanese man was referred to our hospital because of diarrhea with descending colon cancer obstruction. He underwent a left colectomy. Based on immunohistochemistry results, we diagnosed mixed NEC and SCC, the primary lesion location of which was probably the lung in the final pathologic examination. He began systemic palliative chemotherapy with CDDP and CPT-11. After 3 months of treatment, shown the progressive disease, we started CDDP and VP-16. The patient was not eligible for additional chemotherapy after 2 months.

Long-term outcomes of colorectal cancer patients with and without malignant large-bowel obstruction

Aim: Colorectal cancer patients with malignant large-bowel obstruction (MLBO) require emergency treatment. Here we evaluated the long-term outcomes of recurrence and prognosis (not short-term mortality or nonocclusive cancer T1–T2) in colorectal cancer patients with and without an MLBO. Methods: We retrospectively analyzed the cases of the consecutive patients who underwent curative resection for colon cancer. We compared the groups regarding patients’ age and gender, the tumor location, T and N factor, tumor stage, disease-free survival and overall survival. Results: The nonobstruction group had a significantly longer disease-free survival and overall survival compared with the MLBO group. Conclusion: MLBO was associated with cancer recurrence and poorer overall survival regardless of the staging and adjuvant chemotherapy.

Abstract 5928: Discoidin domain receptor-1 (DDR1) is an independent prognostic marker of poor prognosis in esophageal squamous cell carcinoma

Introduction: Esophageal squamous cell carcinoma (ESCC), which is the most common type of esophageal cancer, is one of the most common cancers in eastern Asia and one of the leading causes of cancer-related death worldwide. This unsatisfactory outcome in ESCC is thought to mainly result from late diagnosis, the aggressiveness of this disease, and the lack of the understanding in effective treatment strategies. Therefore, new targetable drugs are required to be investigated and developed in order to improve treatment strategies. The discoidin domain receptors (DDRs) are a set of receptor tyrosine kinases (RTKs) that are activated by collagen and crucial role in key regulators in cancer progression by controlling the interactions of tumor cells with their surrounding collagens. DDR1 is expected to be involved in ESCC, which demonstrates aggressive tumor proliferation and devastating prognosis. However, there have been only a few reports about DDR1 in ESCC. We retrospectively investigated DDR1 in ESCC.

Methods: A total of 60 formalin-fixed paraffin-embedded (FFPE) primary tumor samples were collected from patients with ESCC who underwent surgery with curative intent. DDR1 immunohistochemistry (IHC) was conducted on ESCC FFPE tissue specimens. Clinicopathological factors, DDR1 immunohistochemistry (IHC) and survival data were analyzed in this study.

Results: When compared the clinicopathological factors between the weak and the strong group in the intensity of DDR1 IHC, in univariate analysis there were significant differences between the two groups in age (P=0.007), histological grade (P=0.04), invasion depth (P=0.0001), stage (P&lt; 0.0001). There were no significant differences between the two groups with respect to the other clinicopathological factors. In univariate analysis, significant differences in recurrence-free survival were recognized with respect to invasion depth (T3, 4) (P=0.007), lymph node metastasis (LNM) (N2, 3) (P=0.0005) and DDR1 IHC expression (strong) (P=0.0009). When these clinicopathological factors were used as co-variables for the multivariate analysis, LNM and DDR1 IHC expression were found to be significantly independent prognostic factors (LNM; P=0.04, HR=4.20, DDR1; P=0.03, HR=4.27).

Conclusion: DDR1 IHC expression was found to be useful as a biomarker to predict long-term outcome.

Citation Format: Kiichi Sugimoto, Tomoaki Ito, Hajime Orita, Koichi Sato, Kazuhiro Sakamoto, Mutsumi Sakurada, Tomoyuki Kushida, Hiroshi Maekawa, Ellen Tully, Juhyung Woo, Edward Gabrielson. Discoidin domain receptor-1 (DDR1) is an independent prognostic marker of poor prognosis in esophageal squamous cell carcinoma [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 5928. doi:10.1158/1538-7445.AM2017-5928

A system of delivering medical staff members by helicopter to manage severely wounded patients in an area where medical resources are limited

Aim

We review the case of a severely injured patient to evaluate the system of delivering medical staff by helicopter in areas with limited medical resources.

Methods

The patient's chart was reviewed, summarized, and presented.

Results

A 22‐year‐old woman attempted a suicidal fall after using a knife to stab herself. She was transported to a local hospital. A radiological study revealed fractures to the patient's face and the base of her skull, pneumocephalus, traumatic subarachnoid hemorrhage, stab wounds to the neck and chest, pneumothorax, unstable pelvic fracture, and right femoral shaft fracture. Her circulation status became unstable. We sent medical staff members to the local hospital by doctor helicopter. The patient underwent tracheal intubation and the insertion of a chest drain, and was evacuated by doctor helicopter. After aggressive intensive treatments in our hospital, the patient finally obtained social rehabilitation.

Conclusion

In an area where medical resources are limited, sending trained physicians to a referring hospital to appropriately prepare a severely wounded patient for transportation might be the key for the patient to maximize his or her chance of survival.

Abstract 3424: The efficacy of Gasdermin gene family for tumor marker in colorectal cancer

Gasdermin (GSDM/Gsdm) family was originally identified as a candidate causative gene for a mouse skin mutation, recombination induced mutation 3 (Rim3). It has four human homologs, GSDMA, GSDMB, GSDMC, and GSDMD. All GSDM family members are located in amplicons, genomic regions often amplified during cancer development, and are considered to be involved in the regulation of epithelial apoptosis. GSDMA is mainly expressed in the upper gastrointestinal tract. In contract, GSDMD is expressed in the colorectal tract.

In this study, we researched those expressions in colorectal cancer and evaluated them for tumor marker, comparing between those expressions and clinical pathological status.

We immunohistologically analyzed both expressions of GSDMA and GSDMD, using thirty colorectal cancer cases which were surgically treated at our institution 2013-2014 (Stage1 10 cases, Stage2 10 cases, Stage3a 10cases). Thenretrospectively analyzed the connection, between GSDM expression and clinicopathological data.

GSDMA was no expressed in normal colorectal epithelium, but was overexpressed gradually rising in carcinoma.

However, GSDMD showed the opposite results compared with GSDMA.

The results of the expression analysis suggested that GSDMA and GSDMD act antagonictically with each other in the clinical stage of colorectal cancer.

Citation Format: Hajime Orita, Shigekazu Tanaka, Shunsuke Watanabe, Hirokazu Matsuzawa, Konomi Mizuguchi, Tomoaki Ito, Koji Senuma, Tomoyuki Kushida, Mutsumi Sakurada, Hiroshi Maekawa, Ryo Wada, Koichi Sato. The efficacy of Gasdermin gene family for tumor marker in colorectal cancer. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 3424. doi:10.1158/1538-7445.AM2015-3424

Risk factors for postoperative complications in patients on maintenance hemodialysis who undergo abdominal surgery

BACKGROUND/OBJECTIVE

Patients on hemodialysis (HD) who undergo abdominal surgery for gastrointestinal disease are at increased risk of postoperative complications. In this study, we retrospectively investigated the predictors of postoperative complications among such patients.

METHODS

The study group comprised 36 HD patients who underwent abdominal surgery for gastrointestinal disease between 2003 and 2012. The clinicopathological factors of the patients who did and did not suffer postoperative complications were compared.

RESULTS

The overall morbidity and mortality rates were 39% (14/36) and 14% (5/36), respectively. Physical status according to the American Society of Anesthesiologists (ASA) classification (p = 0.0203) and intraoperative blood loss (p = 0.0013) were found to differ significantly between the groups.

CONCLUSION

The morbidity and mortality rates of HD patients who underwent abdominal surgery for gastrointestinal disease were high. Physical status according to the ASA classification and intraoperative blood loss were found to be associated with postoperative complications. Therefore, patients with comorbidities, such as heart disease and diabetes mellitus, have to be treated appropriately before surgery. In addition, it is important that surgeons perform operations carefully and avoid excessive blood loss.

Introduction of a physician-staffed helicopter emergency medical service in eastern Shizuoka prefecture in Japan

OBJECTIVE

To analyze the operating situation of a physician-staffed helicopter emergency medical service in eastern Shizuoka prefecture.

METHODS

A retrospective analysis was performed using the conveyance records reported by staff members of the physician-staffed helicopter. A comparison between 2007 (n = 619) and 2012 (n = 678) was performed.

RESULTS

There were no significant differences between the 2 groups with regard to the sex, ratio of cardiopulmonary arrest, and survival ratio. In contrast, the duration from the request of dispatch to arrival at the hospital in 2007 was significantly longer than that in 2012 (53.7 vs 48.2 minutes, P < 0.0001). The average age in 2007 was significantly younger than in 2012 (55.7 vs 59.4 years, P < 0.01). The ratio of trauma case in the 2012 was higher than that in 2007 (47 vs 37%, P < 0.001). The ratio of severe cases in 2007 was higher than in 2012 (45 vs 39%, P < 0.05).

CONCLUSION

Japan is an aging society. In eastern Shizuoka prefecture, the increase in the number of trauma and minor injury cases may have increased due to the emphasis on the importance of early medical intervention by the fire department.

Abstract 2143: Inhibiting fatty acid synthase for chemoprevention of chemically induced colorectal tumors

Purpose: Fatty acid synthase (FAS) is overexpressed in colorectal cancer, and we have investigated the potential use of FAS inhibitors for chemoprevention of colorectal cancer.

Experimental Design: Expression of FAS was evaluated in human colorectal lesions and in murine models of colorectal tumorigenesis [AOM and DSS induced colorectal tumors in mice]. Then, the ability of pharmacologic inhibitors of FAS to prevent development of the murine tumors was investigated.

Results: Immunohistochemical studies show that human colorectal cancers express high levels of FAS compared with normal tissues, suggesting that FAS might be a target for intervention in colorectal carcinogenesis. FAS is also expressed at high levels in chemically induced murine colorectal tumors, and the numbers and sizes of those murine tumors are significantly reduced by treating carcinogen-exposed mice with berberine include, Chinese traditional drug, Kampo.

Conclusions: We conclude that increased levels of FAS are common in human colorectal cancer. Based on studies in mouse models, it seems that inhibiting FAS is an effective strategy in preventing and retarding growth of colorectal tumors that have high expression of this enzyme.

Citation Format: Hajime Orita, Sigekazu Tanaka, Hiroshi Maekawa, Mutsumi Sakurada, Tomonori Kushida, Tomoaki Ito, Masahiro Miyazaki, Toshihiko Shiroishi, Koichi Sato. Inhibiting fatty acid synthase for chemoprevention of chemically induced colorectal tumors. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 2143. doi:10.1158/1538-7445.AM2014-2143

Abstract 3257: ERC/mesothelin is expressed in human gastric cancer tissues and cell lines

Background: ERC/mesothelin is expressed in mesothelioma and other malignancies. The ERC/mesothelin gene (MSLN) encodes a 71 kDa precursor protein, which is cleaved to yield 31 kDa N-terminal (N-ERC/mesothelin) and 40 kDa C-terminal (C-ERC/mesothelin) proteins. N-ERC/mesothelin is a soluble protein and has been reported to be a diagnostic serum marker of mesothelioma and ovarian cancer. Gastric cancer tissue also expresses C-ERC/mesothelin, but the significance of serum N-ERC levels for diagnosing gastric cancer has not yet been studied. We examined the latter issue in this study as well as C-ERC/mesothelin expression in human gastric cancer tissues and cell lines.

Methods: We immunohistochemically examined C-ERC/mesothelin expression in tissue samples from 50 cases of gastric cancer, and we also assessed the C-ERC/mesothelin expression of 6 cancer cell lines (MKN-1, MKN-7, MKN-74, NUGC-3, NUGC-4 and TMK-1) using the reverse transcription-polymerase chain reaction, flow cytometry, immunohistochemistry, and immunoblotting. We also examined the N-ERC/mesothelin concentrations of the supernatants of cultured cells and the sera of gastric cancer patients using an ELISA.

Results: N-ERC/mesothelin was detected in the supernatants of 3 cell lines (MKN-1, NUGC-4, and TMK-1) by ELISA, but its concentration in the sera of gastric cancer patients was almost same as that observed in the sera of the normal controls. In the gastric cancer tissues, C-ERC/mesothelin expression was associated with lymphatic invasion, as reported by Einama et al.

Conclusion: N-ERC/mesothelin was secreted into the supernatants of gastric cancer cell lines, but did not appear to be a useful serum marker of gastric cancer.

Citation Format: Tomoaki Ito, Kazunori Kajino, Masaaki Abe, Koichi Sato, Hiroshi Maekawa, Mutsumi Sakurada, Hajime Orita, Ryo Wada, Yoshiaki Kajiyama, Okio Hino. ERC/mesothelin is expressed in human gastric cancer tissues and cell lines. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 3257. doi:10.1158/1538-7445.AM2014-3257

Elevated levels of serum fatty acid synthase in patients with gastric carcinoma

Gastric cancer is the second leading cause of cancer mortality in the world. It is important to develop biomarkers for detecting new cancers at an early stage and for treating them early during recurrence in order to guide optimal treatment. Fatty acid synthase (FAS) is highly expressed in numerous human cancers and thus could potentially serve as such a biomarker, but the potential utility of measuring FAS for detecting gastric cancer has not been previously investigated. The aim of the present study was to provide a preliminary assessment of serum FAS as a marker of gastric carcinoma. The study included 47 patients with gastric cancer and 150 healthy subjects. Blood samples were collected from each cancer patient prior to treatment. Serum FAS levels were measured by ELISA and compared across the two groups of patients. Significantly higher levels of serum FAS were found in the gastric cancer patients [95% confidence interval (CI), 30.37–52.46] compared with the healthy controls (95% CI, 1.331–2.131), with elevated levels even in patients with early-stage tumors. These results indicate that measuring serum FAS levels has strong potential to provide a biomarker for the detection of gastric cancer, with high sensitivity and specificity.

ERC/mesothelin is expressed in human gastric cancer tissues and cell lines

ERC/mesothelin is expressed in mesothelioma and other malignancies. The ERC/mesothelin gene (MSLN) encodes a 71-kDa precursor protein, which is cleaved to yield 31-kDa N-terminal (N-ERC/mesothelin) and 40-kDa C-terminal (C-ERC/mesothelin) proteins. N-ERC/mesothelin is a soluble protein and has been reported to be a diagnostic serum marker of mesothelioma and ovarian cancer. Gastric cancer tissue also expresses C-ERC/mesothelin, but the significance of serum N-ERC levels for diagnosing gastric cancer has not yet been studied. We examined the latter issue in the present study as well as C-ERC/mesothelin expression in human gastric cancer tissues and cell lines. We immunohistochemically examined C-ERC/mesothelin expression in tissue samples from 50 cases of gastric cancer, and we also assessed the C-ERC/mesothelin expression in 6 gastric cancer cell lines (MKN-1, MKN-7, MKN-74, NUGC-3, NUGC-4 and TMK-1) using reverse transcription-polymerase chain reaction, flow cytometry, immunohistochemistry and immunoblotting. We also examined the N-ERC/mesothelin concentrations in the supernatants of cultured cells and in the sera of gastric cancer patients using an enzyme-linked immunosorbent assay (ELISA). N-ERC/mesothelin was detected in the supernatants of 3 gastric cancer cell lines (MKN-1, NUGC-4 and TMK-1) by ELISA, but its concentration in the sera of gastric cancer patients was almost same as that observed in the sera of the normal controls. In the gastric cancer tissues, C-ERC/mesothelin expression was associated with lymphatic invasion. N-ERC/mesothelin was secreted into the supernatants of gastric cancer cell lines, but does not appear to be a useful serum marker of gastric cancer.

Abstract 166: Elevated levels of serum fatty acid synthase (FAS) in patients with gastric carcinoma

Aim: Gastric cancer is the second leading cause of cancer mortality in the world. In East Asia especially, in countries such as China, Japan, and Korea, more than one million new cases are diagnosed each year. The need remains for biomarkers to detect early stage gastric cancer. Fatty acid synthase (FAS) is highly expressed in many human cancers, but the potential utility of measuring FAS for detection of gastric cancer has not been previously investigated. The aim of this study was to provide a preliminary assessment of serum FAS as a marker of gastric carcinoma.

Materials and methods: Our study included 47 patients with gastric cancer (37 men and 10 women, aged 33-89 years) and 150 healthy subjects (113 men and 37 women, aged 33-83 years). Serum

FAS levels were measured by ELISA and compared across the two groups of patients. Blood samples were collected from each cancer patient before treatment, and additionally, post-therapeutic samples were obtained from eleven of the patients with gastric cancer. Measurement data were analyzed using the

Mann-Whitney test. P&lt;0.05 was considered statistically significant. The receiver operator characteristic (ROC) curve was used to determine sensitivity and specificity values.

Results: We found significantly higher levels of serum FAS in gastric cancer patients (95% confidence interval,

95% CI=30.37-52.46) than in healthy controls (95% CI=1.331-2.131), with elevated levels even in patients with early stage tumors. Using 5.5 ng/ml as the cut-off value, the sum of sensitivity (95.74%) and specificity (91.33%) was the highest, and the positive predictive values and negative predictive values were 77.59% and 98.56%, respectively (Area Under the Curve=0.9845,

Standard Error=0.0084, 95% CI=0.9681-1.001). The pre-therapeutic FAS levels were greater than 5.5 ng/ml, and in 8 of 11 patients, the post- therapeutic serum FAS levels decreased to less than 5.5 ng/ml.

Conclusion: Our results suggest that measuring serum FAS levels has strong potential to provide a biomarker for detection of gastric cancer with high sensitivity and high specificity.

Citation Format: Tomoaki Ito, Koichi Sato, Hiroshi Maekawa, Takashi Tada, Mutsumi Sakurada, Hajime Orita, Kazunori Shimada, Ryo Wada, Masaaki Abe, Okio Hino, Yoshiaki Kajiyama. Elevated levels of serum fatty acid synthase (FAS) in patients with gastric carcinoma. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 166. doi:10.1158/1538-7445.AM2013-166

Abstract 25: Pfetin as a risk factor of recurrence in gastrointestinal stromal tumors

Background: Despite complete resection, gastrointestinal stromal tumors (GIST) may recur or metastasize, depending on tumor grade. As such, a sensitive and specific marker is sought to select patients at high risk for recurrence. Previously our group reported Pfetin as prognostic predictors by use of proteomics technology. We used microarray of IHC to identify Pfetin as a statistically significant predictor of prognosis in resected GIST. In this project, we evaluated the role of Pfetin expression by IHC, controlled for clinicopathological data, as a predictor for recurrence.

Methods: 45 patients with primary GIST were treated with complete (R0) resection at our institution between 1995 and 2009. Tumors originated in the stomach (38 cases), small intestine (6 cases), and rectum (1 case).

Results: There were 8 recurrences, with the following characteristics. (1) Pfetin negative cases were significantly related to recurrence (p=0.002). (2) By univariate analysis, tumor size, mitoses, dissemination (tumor explosion), invasion (other organ) as well as Pfetin were significant predictors. According to multivariate analysis using these 5 factors, tumor mitosis and Pfetin were the most significant risks (p=0.059). (3) All 8 cases of recurrence were grouped as high risk according to Fletcher's classification. This demonstrated high accuracy.

Conclusions: We determined that tumor mitoses and Pfetin under-expression correlate with recurrence. These markers may have utility in selecting patients for adjuvant therapy.

Citation Format: Hajime Orita, Tomoaki Ito, Mutsumi Sakurada, Tomoyuki Kushida, Hiroshi Maekawa, Ryo Wada, Yoshiyuki Suehara, Daisuke Kubota, Tadashi Kondo, Koichi Sato. Pfetin as a risk factor of recurrence in gastrointestinal stromal tumors. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 25. doi:10.1158/1538-7445.AM2013-25

Analysis of the efficacy of direct hemoperfusion with polymyxin B-immobilized fiber (PMX-DHP) according to the prognostic factors in patients with colorectal perforation

PURPOSE

Direct hemoperfusion with polymyxin B-immobilized fiber (PMX-DHP) has been reported to improve the outcomes in patients with colorectal perforation. We retrospectively identified prognostic factors in patients with colorectal perforation and considered the efficacy of PMX-DHP based on these prognostic factors.

METHODS

One hundred and fifty-six patients who underwent surgery for colorectal perforation in our department between November 1995 and March 2011 were enrolled in this study. The clinicopathological factors were compared between the survivor and non-survivor groups.

RESULTS

There were 28 patients (17.9 %) who died within 28 days after surgery. According to the multivariate analysis, an Acute Physiology and Chronic Health Evaluation II (APACHE II) score of 17 or more was a significant independent prognostic factor (P = 0.002, odds ratio = 5.39). There was a significant difference in the survival rates between the patients with APACHE II scores of 16 or less and those with scores of 17 or more who had received the PMX-DHP (+) (P < 0.0001).

CONCLUSION

The APACHE II score is useful as a prognostic factor in patients with colorectal perforation, and the survival rate was 50 % or lower among the patients with APACHE II scores of 17 or higher. Therefore, PMX-DHP appears to have limited efficacy in serious cases.

Unroofing technique for endoscopic resection of a large colonic lipoma

A 77-year-old man presented with repeated episodes of melena. He had a medical history of hypertension, atrial fibrillation and cardiogenic brain infarction and took medications, i.e. an antiplatelet agent. Laboratory data revealed iron deficiency anemia. Colonoscopy revealed a yellowish smooth submucosal tumor, 50 mm in diameter, on the Bauhin valve. The lesion was soft and compressible. The overlying mucosa was erosive. CT scan showed a uniform mass with very low density in the ascending colon, corresponding to the above-detected lesion. The clinical diagnosis of colonic lipoma was established. Using a 25 mm electrocautery snare (Olympus, Tokyo, Japan), we transected the upper portion of the mass to unroof the lesion. The mucosa layer was thick and hard. Fat tissue was observed extruding from the cut surface, consistent with the diagnostic hypothesis. After dissecting the overlying mucosa on the anal side by means of an IT knife (Olympus) in order to completely extrude the mass, the fat tissue was further exposed. It took about 26 min to perform the whole procedure. There were no procedure-related complications. Macroscopically, the resected lesion was a yellow solid tumor, 1.6 × 1.5 × 0.7 cm in diameter. Histopathologic examination of the excised specimen confirmed the diagnosis of a lipoma. The clinical course was uneventful. A follow-up endoscopy 1 month later showed a scarred mucosa at the resection site. Similarly, a follow-up CT scan 2 months later revealed no evidence of residual lipoma. The unroofing technique is safe, easy and suitable for the treatment of large lipomas.

The differences in the stage classification for node-positive colorectal cancer between the United States and Japan: A single institution experience

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Background: In the United States, the stage classification by the number of lymph node metastasis (LNM) is adopted in TNM classification 7th edition. In Japan, the stage classification by the distribution of LNM was modified to that by the number of LNM in order to integrate with TNM classification in Japanese classification of colorectal carcinoma second English edition. We retrospectively examined the possibility of predicting prognosis by the number of LNM and considered the differences between TNM classification and Japanese classification. Methods: Two hundred and seventy-five patients with LNM who underwent curative surgery for colorectal cancer at our department between January 1992 and December 2004 were enrolled in this study. All patients were followed for 5 years after the operation. At first, we calculated cancer-specific survivals according to the number of LNM in order to examine whether the stratifications of prognosis by the number of LNM is appropriate or not. Secondary, clinicopathological factors and survival data were analyzed to determine prognostic factors. Finally, we considered the differences between TNM classification and Japanese classification. Results: When comparing cancer-specific survivals between the patients with the number of LNM of 1 and 2-3 and 4 or more, cancer-specific survivals were well stratified (both; p=0.006). According to the multivariate analysis using clinicopathological factors, invasion depth (T4) (p=0.007, odds ratio=2.230), venous invasion (moderate-severe) (p=0.003, odds ratio=2.577) and the number of LNM (p=0.0002, odds ratio=1.201) were significantly independent prognostic factors. In Japanese classification, there was a significant difference in cancer-specific survivals between Stage IIIa and IIIb (p<0.0001). On the other hand, in TNM classification, cancer-specific survivals in Stage IIIA, IIIB and IIIC were stratified into three groups with significant differences (IIIA vs IIIB; P=0.01, IIIB vs IIIC; p<0.0001). Conclusions: In comparison of Japanese classification and TNM classification, TNM classification seems to be superior to Japanese classification.

Intraoperative blood transfusion contributes to decreased long-term survival of patients with esophageal cancer

BACKGROUND

Several prognostic factors for patients who have undergone esophagectomy owing to esophageal squamous cell carcinoma have been suggested, including intraoperative blood loss. There are few data, however, suggesting such an association with the prognosis following radical esophagectomy.

METHODS

Patients with esophageal squamous cell carcinoma who underwent radical esophagectomy were divided into two groups based on the median value of the intraoperative blood loss (510 g). A multivariate Cox proportional-hazard regression analysis was performed to determine if intraoperative blood loss could be an independent prognostic factor for long-term survival following radical esophagectomy. Kaplan-Meier survival analysis with a log-rank test was performed between the groups.

RESULTS

From April 2005 to May 2009, a total of 37 patients underwent radical esophagectomy for the treatment of esophageal squamous cell carcinoma at the Juntendo Shizuoka Hospital and were assigned either to one of two groups: those with ≥510 g blood loss [bleeding group (BG), n = 19] or of those with <510 g blood loss [less bleeding group (LBG), n = 18]. The distribution of the stage of disease, the number of positive lymph nodes, and the presence of lymphatic and vascular invasion was comparable between the groups, but the Kaplan-Meier survival analysis demonstrated that survival was significantly worse in the BG group than in the LBG group (p = 0.00295). This was supported by the multivariate analysis, which indicated that intraoperative blood loss was independently associated with long-term survival after radical esophagectomy.

CONCLUSIONS

Intraoperative blood loss could be a useful prognostic factor following radical esophagectomy in patients with esophageal squamous cell carcinoma.

Novel short-duration heating balloon dilatation with uniform temperature distribution: the heating conditions to suppress neo-intimal hyperplasia

We investigate the relation between the influences on smooth muscle cells and the chronic performances of our novel short-duration heating balloon dilatation to reveal the heating conditions which can suppress the neo-intimal hyperplasia after our heating dilatations. The temperature of prototype balloon catheter surface was measured during short-duration heating balloon dilatation ex vivo. There existed 2 °C temperature variations in the long direction of prototype balloon catheter at a maximum. The neo-intimal hyperplasia occupancy rate after our short-duration heating dilatations were measured in vivo porcine study. The neo-intimal hyperplasia was suppressed most at 75 °C in balloon peak temperature in vivo. The estimated dead rate of smooth muscle cells at this condition was about 13% by the Arrhenius equation. We think that the suppression of neo-intimal hyperplasia was obtained after our short-duration heating dilatation due to the proper decrease of smooth muscle cells by heating and no thermal damages to the adventitia and surrounding tissues.

Direct hemoperfusion with polymyxin B immobilized fiber for abdominal sepsis in Europe

Since direct hemoperfusion with polymyxin B immobilized fiber (PMX-DHP) received its product certification for use in Europe in 1998, several prospective randomized controlled trials (RCTs) have been conducted in European countries. The first RCT, performed in six European academic medical centers in 2005, concluded that PMX-DHP is associated with improved hemodynamic status and cardiac function. Subsequently, a meta-analysis of PMX-DHP was presented in Italy in 2007. This systematic review found positive effects of PMX-DHP on mean arterial pressure and dopamine/ dobutamine use, PaO2/FiO2 ratio, endotoxin removal, and mortality. However, like most trials on extracorporeal therapies, none of the studies was double-blinded. The EUPHAS study, a multicenter RCT performed in ten Italian intensive care units in 2009, found that PMX-DHP improved 28-day survival, blood pressure, vasopressor requirement, and degree of organ failure. However, investigators in Belgium and Canada pointed out that there was no statistical difference in 28-day survival. Two more RCTs, the ABDO-MIX and EUPHRATES studies, the primary end points of which are 28-day mortality, were started in Europe and the United States at the end of 2010. We are hoping that these RCTs will resolve this issue.

Adult intussusception caused by an inverted meckel diverticulum

Adult intussusception caused by an inverted Meckel diverticulum is rare. We report a 55-year-old Japanese man with intussusception. He was admitted to our hospital with vomiting and abdominal pain. The abdomen was hard with tenderness and muscle guarding. Computed tomography scanning demonstrated a typical inhomogeneous target-shaped mass in the right abdomen. We diagnosed intussusception and performed emergency surgery. At laparotomy, ileocolic intussusception was observed and the ileocecal segment was resected. The surgical specimen comprised an 84 cm segment of resected ileocecum with an elongated polypoid lesion measuring 11 × 2 cm within the ileal lumen. Histopathological examination demonstrated that the polypoid lesion was an inverted Meckel diverticulum. Postoperatively, the patient made an uneventful recovery.

Signet-ring cell carcinoma co-existing with adenocarcinoma of the ampulla of vater. A case report

CONTEXT

We report a case of signet-ring cell carcinoma admixed with adenocarcinoma of the ampulla of Vater. Signet-ring cell carcinoma of the ampulla of Vater is rarely encountered in clinical practice.

CASE REPORT

A 78-year-old man was admitted to our hospital with jaundice. Computed tomography demonstrated dilatation of the biliary tract and an enhanced mass lesion measuring 1.5 cm in the pancreatic head. Endoscopic examination showed a reddish swollen papilla of Vater, and the pathological findings on a biopsy from the papilla suggested signet-ring cell carcinoma. A pancreaticoduodenectomy was performed with a diagnosis of carcinoma of the ampulla of Vater. Postoperative pathological examination showed that the tumor was composed of signet-ring cell carcinoma and tubular adenocarcinoma. The signet-ring cell carcinoma had infiltrated to the duodenal wall and pancreatic parenchyma. Both the signet-ring cell carcinoma and the adenocarcinoma were positive on immunohistochemical staining with 45M1.

CONCLUSION

Several cases of signet-ring cell carcinoma of the ampulla of Vater have previously been reported. In our case, the histological origin of both signet-ring cell and adenocarcinoma was hypothesized to have been pancreaticobiliary epithelial cells.

Abstract 881: Clinical usefulness of soluble fibrin monomer-fibrinogen complex (SFMC) for the metastasis of malignant neoplasm

Objective: SF is a complex coupling fibrin monomer and fibrinogen molecules to be formed in the early-activated state of blood coagulation. The level of SF reflects the thrombin generation activity in plasma. There is increasing evidence that SFMC is expected to serve as a parameter for thrombus formation and DIC, in particular its early stage.

Thrombin generation is activated in the metastasis of malignant neoplasm,

The aim of this study is to determine whether the SF could be a new marker for the metastasis of malignant neoplasm.

Material and Methods: From 2007 to 2008, a total of 86 patients who underwent radical surgery for treatment to the cancer of digestive organs (including cancer of esophagus, stomach, colon, rectum, liver, biliary tract, and pancreas) were enrolled in this study.

We measured SF together with established tumor markers before the surgery and every three months after the surgery. Each of them was compared with imaging tests such as CT scan, ultrasounds, MRI, PET-CT, GIF, and CF.

Results: There were not admitted the rise of SF neither before nor after surgery in the case of stage1 and 2. No metastasis was admitted with the imaging tests in the cases of stage1 and 2, either. In the cases of stage3 and 4, there were some cases with the rise of SF before the surgery. The decrease of SF and tumor markers were admitted in the cases of excising the radical cure. SF was not high in the some cases with relapse or metastasis which condition was considered to be suppressed by chemotherapy and radiotherapy. Moreover, the rise of SF was admitted in all samples in the case of multiple liver metastasis and multiple peritoneal dissemination.

Conclusions: Though this study suggests that SF could be a parameter for the condition of metastatic malignant neoplasm, it has not been systematically studied whether SF is useful for early detection of metastasis and relapse or not.

Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 101st Annual Meeting of the American Association for Cancer Research; 2010 Apr 17-21; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2010;70(8 Suppl):Abstract nr 881.

Pancreatic lymphoepithelial cyst with an intracystic papillary projection. Report of a case

CONTEXT

Lymphoepithelial cysts of the pancreas show various presentations on imaging studies often making a differential diagnosis difficult.

CASE REPORT

A 58-year-old man was admitted to our hospital with epigastric discomfort and abdominal bloating. Abdominal US was carried out and demonstrated a cystic lesion 5 cm in diameter which included an intracystic projection into the pancreatic body. This intracystic projection was also seen on CT and MR images. On FDG-PET images, the projection was positively visualized. Since we could not exclude a pancreatic cystic neoplasm, a distal pancreatectomy was performed. Postoperative pathological examination demonstrated that the lesion was a lymphoepithelial cyst of the pancreas. There were no atypical cells in the intracystic projection.

CONCLUSION

Resection is inevitable when a true pancreatic neoplasm cannot be excluded.

The Tokyo subway sarin attack--lessons learned

The sarin gas attack in the Tokyo subway system is reviewed from a clinical toxicology perspective. Based on the lessons learned from this attack, the following areas should be addressed on a global scale. First, an adequate supply of protective equipment is required, including level B protective equipment with a pressure demand breathing apparatus. In addition, a system should be established that enables a possible cause to be determined based on symptoms, physical findings, general laboratory tests, and a simple qualitative analysis for poisonous substances. If an antidote is needed, the system should enable it to be administered to the victims as quickly as possible. Preparation for a large-scale chemical attack by terrorists requires the prior establishment of a detailed decontamination plan that utilizes not only mass decontamination facilities but also public facilities in the area. A system should be established for summarizing, evaluating, and disseminating information on poisonous substances. Finally, a large-scale scientific investigation of the Tokyo sarin attack should be conducted to examine its long-term and subclinical effects and the effects of exposure to asymptomatic low levels of sarin.

Superiority of minipool nucleic acid amplification technology for hepatitis B virus over chemiluminescence immunoassay for hepatitis B surface antigen screening

BACKGROUND AND OBJECTIVES

The Japanese Red Cross (JRC) have developed a fully automated multiplex (MPX) nucleic acid amplification technology (NAT) system for hepatitis B virus (HBV), hepatitis C virus (HCV) and human immunodeficiency virus 1 (HIV-1). This is used to test serologically negative blood units from volunteer, non-remunerated donors. The system utilizes a 50-sample pool for NAT screening with an input volume of each pool. This results in a significantly higher sensitivity for hepatitis B than that seen with highly sensitive hepatitis B surface antigen (HBsAg) testing.

MATERIALS AND METHODS

From 1 February 2000 to 15 October 2001, over 11 million donations, which were serologically negative, were tested using the MPX NAT system. Donations found to be HBV DNA positive were further tested by using the chemiluminescence immunoassay (CLIA).

RESULTS

Out of 181 HBV DNA-positive donations, 96 (53%) and 76 (42%) were negative by individual enzyme immunoassay (EIA) and CLIA testing, respectively.

CONCLUSIONS

The sensitivity of the 50-sample pool MPX NAT system was higher than that of individual HBsAg screening by CLIA. By adopting this NAT-screening system, the JRC has improved the safety of the blood supply and maintained supply across Japan.

Effects of aflastatin A, an inhibitor of aflatoxin production, on aflatoxin biosynthetic pathway and glucose metabolism in Aspergillus parasiticus

Aflastatin A inhibits aflatoxin production by Aspergillus parasiticus via an unknown mechanism. We found that aflastatin A clearly inhibited production of norsolorinic acid, an early biosynthetic intermediate of aflatoxin, at a concentration of 0.25 microg/ml. Reverse-transcriptase polymerase chain reaction (RT-PCR), and real-time quantitative PCR (TaqMan PCR) experiments indicated that the transcription of genes encoding aflatoxin biosynthetic enzymes (pksA, ver-1, and omtA) and a gene encoding a regulatory protein for expression of the biosynthetic enzymes (aflR) were significantly reduced by the addition of aflastatin A. We also found that aflastatin A elevated the glucose consumption and ethanol accumulation by A. parasiticus, and repressed transcription of genes involved in ethanol utilization. These results suggest that aflastatin A inhibits a very early step in aflatoxin biosynthesis prior to the transcription of aflR and can influence glucose metabolism in the fungus.

Intraperitoneal PACAP administration decreases blood glucose in GK rats, and in normal and high fat diet mice

PACAP is an islet peptide that serves as an endogenous amplifier of glucose induced insulin secretion. Furthermore, we has recently found that PACAP also potentiates insulin stimulated glucose uptake in adipocytes. Therefore, an antidiabetic action of PACAP is possible. In the present study, we examined the effect of PACAP treatment of the hyperglycemia in GK rats, an animal model of type 2 diabetes, and in high fat fed C47BL/6J mice, an animal model for glucose intolerance. GK rats housed with normal diet exhibited a normal level of blood glucose until three weeks old but significant hyperglycemia at eight weeks. When GK rats were treated with daily PACAP38 (i.p. injection, 6 pmol/kg) from age three weeks, development of hyperglycemia was prevented. In high fat fed mice, i.p. administration of PACAP27 for five (25 nmol/kg twice daily) reduced plasma glucose levels to 6.9 +/- 0.2 mmol/l compared to 8.1 +/- 0.2 mmol/l in saline injected animals (p < 0.001) without altering baseline insulin levels. We conclude that PACAP reduces circulating glucose in animal models of type 2 diabetes and glucose intolerance. The mechanism of this action needs to be established.

Blasticidin A derivatives with highly specific inhibitory activity toward aflatoxin production in Aspergillus parasiticus

Blasticidin A (1), an antibiotic, has strong inhibitory activity toward aflatoxin production by Aspergillus parasiticus. We prepared some derivatives of 1 and examined their biological activities. Among them, derivatives 3 and 4 without the tetramic acid moiety of 1 maintained inhibitory activity toward aflatoxin production, but did not show antifungal activity or toxicity. RT-PCR experiments indicated that derivatives 3 and 4 as well as 1 significantly reduced the expression of genes encoding aflatoxin biosynthetic enzymes (pksA, ver-1 and omtA) and a regulatory gene (aflR) in A. parasiticus. These results suggested that derivatives 3 and 4 can inhibit aflatoxin production more specifically than 1 by inhibiting an early step prior to the expression of aflR in the pathway of aflatoxin biosynthesis.