SOX17 enables immune evasion of early colorectal adenomas and cancers

A hallmark of cancer is the avoidance of immune destruction. This process has been primarily investigated in locally advanced or metastatic cancer1-3; however, much less is known about how pre-malignant or early invasive tumours evade immune detection. Here, to understand this process in early colorectal cancers (CRCs), we investigated how naive colon cancer organoids that were engineered in vitro to harbour Apc-null, KrasG12D and Trp53-null (AKP) mutations adapted to the in vivo native colonic environment. Comprehensive transcriptomic and chromatin analyses revealed that the endoderm-specifying transcription factor SOX17 became strongly upregulated in vivo. Notably, whereas SOX17 loss did not affect AKP organoid propagation in vitro, its loss markedly reduced the ability of AKP tumours to persist in vivo. The small fraction of SOX17-null tumours that grew displayed notable interferon-γ (IFNγ)-producing effector-like CD8+ T cell infiltrates in contrast to the immune-suppressive microenvironment in wild-type counterparts. Mechanistically, in both endogenous Apc-null pre-malignant adenomas and transplanted organoid-derived AKP CRCs, SOX17 suppresses the ability of tumour cells to sense and respond to IFNγ, preventing anti-tumour T cell responses. Finally, SOX17 engages a fetal intestinal programme that drives differentiation away from LGR5+ tumour cells to produce immune-evasive LGR5- tumour cells with lower expression of major histocompatibility complex class I (MHC-I). We propose that SOX17 is a transcription factor that is engaged during the early steps of colon cancer to orchestrate an immune-evasive programme that permits CRC initiation and progression.

Stiffness Restricts the Stemness of the Intestinal Stem Cells and Skews Their Differentiation Toward Goblet Cells

BACKGROUND & AIMS

Fibrosis and tissue stiffening are hallmarks of inflammatory bowel disease (IBD). We have hypothesized that the increased stiffness directly contributes to the dysregulation of the epithelial cell homeostasis in IBD. Here, we aim to determine the impact of tissue stiffening on the fate and function of the intestinal stem cells (ISCs).

METHODS

We developed a long-term culture system consisting of 2.5-dimensional intestinal organoids grown on a hydrogel matrix with tunable stiffness. Single-cell RNA sequencing provided stiffness-regulated transcriptional signatures of the ISCs and their differentiated progeny. YAP-knockout and YAP-overexpression mice were used to manipulate YAP expression. In addition, we analyzed colon samples from murine colitis models and human IBD samples to assess the impact of stiffness on ISCs in vivo.

RESULTS

We demonstrated that increasing the stiffness potently reduced the population of LGR5+ ISCs and KI-67+-proliferating cells. Conversely, cells expressing the stem cell marker, olfactomedin-4, became dominant in the crypt-like compartments and pervaded the villus-like regions. Concomitantly, stiffening prompted the ISCs to preferentially differentiate toward goblet cells. Mechanistically, stiffening increased the expression of cytosolic YAP, driving the extension of olfactomedin-4+ cells into the villus-like regions, while it induced the nuclear translocation of YAP, leading to preferential differentiation of ISCs toward goblet cells. Furthermore, analysis of colon samples from murine colitis models and patients with IBD demonstrated cellular and molecular remodeling reminiscent of those observed in vitro.

CONCLUSIONS

Collectively, our findings highlight that matrix stiffness potently regulates the stemness of ISCs and their differentiation trajectory, supporting the hypothesis that fibrosis-induced gut stiffening plays a direct role in epithelial remodeling in IBD.

Inulin diet uncovers complex diet-microbiota-immune cell interactions remodeling the gut epithelium

BACKGROUND

The continuous proliferation of intestinal stem cells followed by their tightly regulated differentiation to epithelial cells is essential for the maintenance of the gut epithelial barrier and its functions. How these processes are tuned by diet and gut microbiome is an important, but poorly understood question. Dietary soluble fibers, such as inulin, are known for their ability to impact the gut bacterial community and gut epithelium, and their consumption has been usually associated with health improvement in mice and humans. In this study, we tested the hypothesis that inulin consumption modifies the composition of colonic bacteria and this impacts intestinal stem cells functions, thus affecting the epithelial structure.

METHODS

Mice were fed with a diet containing 5% of the insoluble fiber cellulose or the same diet enriched with an additional 10% of inulin. Using a combination of histochemistry, host cell transcriptomics, 16S microbiome analysis, germ-free, gnotobiotic, and genetically modified mouse models, we analyzed the impact of inulin intake on the colonic epithelium, intestinal bacteria, and the local immune compartment.

RESULTS

We show that the consumption of inulin diet alters the colon epithelium by increasing the proliferation of intestinal stem cells, leading to deeper crypts and longer colons. This effect was dependent on the inulin-altered gut microbiota, as no modulations were observed in animals deprived of microbiota, nor in mice fed cellulose-enriched diets. We also describe the pivotal role of γδ T lymphocytes and IL-22 in this microenvironment, as the inulin diet failed to induce epithelium remodeling in mice lacking this T cell population or cytokine, highlighting their importance in the diet-microbiota-epithelium-immune system crosstalk.

CONCLUSION

This study indicates that the intake of inulin affects the activity of intestinal stem cells and drives a homeostatic remodeling of the colon epithelium, an effect that requires the gut microbiota, γδ T cells, and the presence of IL-22. Our study indicates complex cross kingdom and cross cell type interactions involved in the adaptation of the colon epithelium to the luminal environment in steady state. Video Abstract.

Abstract 1352: SOX17 plays a critical role in immune evasion of colorectal cancer

Colorectal cancers (CRCs) are a leading cause of cancer-related death. Most CRCs are immune cold, and do not respond to checkpoint blockade therapy except for microsatellite-high CRCs harboring high mutational burdens. Deciphering the mechanism by which CRC cells evade immune surveillance has the potential to dramatically improve the prognosis of CRC patients. During tumor evolution of CRCs, epigenetic changes play critical roles in addition to accumulation of genetic mutations. However, distinct mutational patterns and patient backgrounds render it challenging to distinguish the driver epigenetic alterations from passenger epigenetic alterations induced by gene mutations or other environmental factors. Identification of the driver epigenetic alterations may provide novel mechanistic insights into colon cancer biology including how they evade immune surveillance. Here, we utilized the colon cancer organoid orthotopic transplantation approach to establish colon cancer organoids from different stages of the tumors, and performed comprehensive epigenomic and transcriptomic analyses to understand the epigenetic alterations during tumor evolution. We found that in vivo environment induces epigenetic alterations that converge on SOX17, a transcription factor that is required for endoderm development. SOX17 is re-expressed in colon cancers in vivo, but not in the in vitro organoid culture, and reprograms tumor cell fate with fetal intestinal gene expressions. Importantly, SOX17 knockout leads to tumor rejection in immunocompetent mice, but not in immunodeficient mice, by turning immune cold tumors into hot tumors with robust intratumoral infiltration of activated CD8+ T cells. Mechanistically, SOX17 directly downregulates Ifngr1 expression and mitigates MHC-I expression to evade CD8+ T cell-mediated tumor cell killing. Together, our result reveals that SOX17 is a master transcription factor that induces the in vivo epigenetic reprograming of tumors, which contributes to the immune evasion of colon cancers.

Citation Format: Norihiro Goto, Saori Goto, Peter Westcott, Shinya Imada, Judith Agudo, Omer Yilmaz. SOX17 plays a critical role in immune evasion of colorectal cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 1352.

Post-fast refeeding enhances intestinal stem cell-mediated regeneration and tumourigenesis through mTORC1-dependent polyamine synthesis

For more than a century, fasting regimens have improved health, lifespan, and tissue regeneration in diverse organisms, including humans. However, how fasting and post-fast refeeding impact adult stem cells and tumour formation has yet to be explored in depth. Here, we demonstrate that post-fast refeeding increases intestinal stem cell (ISC) proliferation and tumour formation: Post-fast refeeding augments the regenerative capacity of Lgr5+ intestinal stem cells (ISCs), and loss of the tumour suppressor Apc in ISCs under post-fast refeeding leads to a higher tumour incidence in the small intestine and colon than in the fasted or ad libitum (AL) fed states. This demonstrates that post-fast refeeding is a distinct state. Mechanistically, we discovered that robust induction of mTORC1 in post-fast-refed ISCs increases protein synthesis via polyamine metabolism to drive these changes, as inhibition of mTORC1, polyamine metabolite production, or protein synthesis abrogates the regenerative or tumourigenic effects of post-fast refeeding. Thus, fast-refeeding cycles must be carefully considered when planning diet-based strategies for regeneration without increasing cancer risk, as post-fast refeeding leads to a burst not only in stem cell-driven regeneration but also in tumourigenicity.

Lymphatics and fibroblasts support intestinal stem cells in homeostasis and injury

Lgr5⁺ intestinal stem cells (ISCs) depend on niche factors for their proper function. However, the source of these ISC niche factors and how they support ISCs in vivo remain controversial. Here, we report that ISCs depend on lymphatic endothelial cells (LECs) and RSPO3⁺GREM1⁺ fibroblasts (RGFs). In the intestine and colon, LECs are surrounded by RGFs and are located near ISCs at the crypt base. Both LECs and RGFs provide the critical ISC niche factor RSPO3 to support ISCs, where RSPO3 loss in both cell types drastically compromises ISC numbers, villi length, and repair after injury. In response to injury, LEC and RGF numbers expand and produce greater amounts of RSPO3 and other growth/angiocrine factors to foster intestinal repair. We propose that LECs represent a novel niche component for ISCs, which together with RGFs serve as the major in vivo RSPO3 source for ISCs in homeostasis and injury-mediated regeneration.

Screening for modulators of the cellular composition of gut epithelia via organoid models of intestinal stem cell differentiation

The cellular composition of barrier epithelia is essential to organismal homoeostasis. In particular, within the small intestine, adult stem cells establish tissue cellularity, and may provide a means to control the abundance and quality of specialized epithelial cells. Yet, methods for the identification of biological targets regulating epithelial composition and function, and of small molecules modulating them, are lacking. Here we show that druggable biological targets and small-molecule regulators of intestinal stem cell differentiation can be identified via multiplexed phenotypic screening using thousands of miniaturized organoid models of intestinal stem cell differentiation into Paneth cells, and validated via longitudinal single-cell RNA-sequencing. We found that inhibitors of the nuclear exporter Exportin 1 modulate the fate of intestinal stem cells, independently of known differentiation cues, significantly increasing the abundance of Paneth cells in the organoids and in wild-type mice. Physiological organoid models of the differentiation of intestinal stem cells could find broader utility for the screening of biological targets and small molecules that can modulate the composition and function of other barrier epithelia.

High-fat diet-activated fatty acid oxidation mediates intestinal stemness and tumorigenicity

Obesity is an established risk factor for cancer in many tissues. In the mammalian intestine, a pro-obesity high-fat diet (HFD) promotes regeneration and tumorigenesis by enhancing intestinal stem cell (ISC) numbers, proliferation, and function. Although PPAR (peroxisome proliferator-activated receptor) nuclear receptor activity has been proposed to facilitate these effects, their exact role is unclear. Here we find that, in loss-of-function in vivo models, PPARα and PPARδ contribute to the HFD response in ISCs. Mechanistically, both PPARs do so by robustly inducing a downstream fatty acid oxidation (FAO) metabolic program. Pharmacologic and genetic disruption of CPT1A (the rate-controlling enzyme of mitochondrial FAO) blunts the HFD phenotype in ISCs. Furthermore, inhibition of CPT1A dampens the pro-tumorigenic consequences of a HFD on early tumor incidence and progression. These findings demonstrate that inhibition of a HFD-activated FAO program creates a therapeutic opportunity to counter the effects of a HFD on ISCs and intestinal tumorigenesis.

Abstract 6007: Post-fasting refeeding enhances intestinal stem cell-mediated regeneration and tumorigenesis

Although short-term fasting interventions improve intestinal stem cell (ISC) function, little is known about how much of this benefit comes from fasting versus the post-fasting refeeding response. Given the central role that ISCs play in driving injury-induced repair and in initiating early intestinal tumors, it is possible that fasting by boosting ISC function not only improves regeneration but also unexpectedly elevates intestinal tumorigenesis. To understand how fasting/refeeding interventions influence the role of ISCs in regeneration and early tumor formation, we assessed the function of ISCs to repair the intestinal lining after injury and to contribute to intestinal tumors. Notably, we find that 24 hours post-fasting refeeding boosts intestinal stem and progenitor cells proliferation and increases ISC function in organoid and in fate mapping assays compared to AL and fasted cohorts. Mechanistically, elevated mammalian target of rapamycin (mTOR) activity mediates the effects of refeeding in ISCs as treatment with mTOR inhibitor blocks these effects. Surprisingly, loss of the APC tumor suppressor gene in ISCs increased intestinal tumor numbers in the refed state compared to the AL and fasted states in an mTOR dependent manner. We propose that refeeding through mTOR signaling stimulates ISC function and in a context-dependent manner this can either improve repair after injury or promote intestinal tumorigenesis.

Citation Format: Shinya Imada. Post-fasting refeeding enhances intestinal stem cell-mediated regeneration and tumorigenesis [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 6007.

Ketone Body Signaling Mediates Intestinal Stem Cell Homeostasis and Adaptation to Diet

Little is known about how metabolites couple tissue-specific stem cell function with physiology. Here we show that, in the mammalian small intestine, the expression of Hmgcs2 (3-hydroxy-3-methylglutaryl-CoA synthetase 2), the gene encoding the rate-limiting enzyme in the production of ketone bodies, including beta-hydroxybutyrate (βOHB), distinguishes self-renewing Lgr5⁺ stem cells (ISCs) from differentiated cell types. Hmgcs2 loss depletes βOHB levels in Lgr5⁺ ISCs and skews their differentiation toward secretory cell fates, which can be rescued by exogenous βOHB and class I histone deacetylase (HDAC) inhibitor treatment. Mechanistically, βOHB acts by inhibiting HDACs to reinforce Notch signaling, instructing ISC self-renewal and lineage decisions. Notably, although a high-fat ketogenic diet elevates ISC function and post-injury regeneration through βOHB-mediated Notch signaling, a glucose-supplemented diet has the opposite effects. These findings reveal how control of βOHB-activated signaling in ISCs by diet helps to fine-tune stem cell adaptation in homeostasis and injury.

Atomoxetine, a selective norepinephrine reuptake inhibitor, improves short-term histological outcomes after hypoxic-ischemic brain injury in the neonatal male rat

BACKGROUND

Despite the recent progress of perinatal medicine, perinatal hypoxic-ischemic (HI) insult remains an important cause of brain injury in neonates, and is pathologically characterized by neuronal loss and the presence of microglia. Neurotransmitters, such as norepinephrine (NE) and glutamate, are involved in the pathogenesis of hypoxic-ischemic encephalopathy via the interaction between neurons and microglia. Although it is well known that the monoamine neurotransmitter NE acts as an anti-inflammatory agent in the brain under pathological conditions, its effects on perinatal HI insult remains elusive. Atomoxetine, a selective NE reuptake inhibitor, has been used clinically for the treatment of attention-deficit hyperactivity disorder in children. Here, we investigated whether the enhancement of endogenous NE by administration of atomoxetine could protect neonates against HI insult by using the neonatal male rat model. We also examined the involvement of microglia in this process.

METHODS

Unilateral HI brain injury was induced by the combination of left carotid artery dissection followed by ligation and hypoxia (8% O₂, 2 h) in postnatal day 7 (P7) male rat pups. The pups were randomized into three groups: the atomoxetine treatment immediately after HI insult, the atomoxetine treatment at 3 h after HI insult, or the vehicle treatment group. The pups were euthanized on P8 and P14, and the brain regions including the cortex, striatum, hippocampus, and thalamus were evaluated by immunohistochemistry.

RESULTS

HI insult resulted in severe brain damage in the ipsilateral hemisphere at P14. Atomoxetine treatment immediately after HI insult significantly increased NE levels in the ipsilateral hemisphere at 1 h after HI insult and reduced the neuronal damage via the increased phosphorylation of cAMP response element-binding protein (pCREB) in all brain regions examined. In addition, the number of microglia was maintained under atomoxetine treatment compared with that of the vehicle treatment group. To determine the involvement of microglia in the process of neuronal loss by HI insult, we further examined the influence of hypoxia on rat primary cultured microglia by the quantitative real-time polymerase chain reaction. Hypoxia did not cause the upregulation of interleukin-1beta (IL-1β) mRNA expression, but decreased the microglial intrinsic nitric oxide synthase (iNOS)/arginase1 mRNA expression ratio. NE treatment further decreased the microglial iNOS/arginase1 mRNA expression ratio. In contrast, no significant neuroprotective effect was observed at P14 when atomoxetine was administered at 3 h after HI insult.

CONCLUSIONS

These findings suggested that the enhancement of intrinsic neurotransmitter NE signaling by a selective NE reuptake inhibitor, atomoxetine, reduced the perinatal HI insult brain injury. In addition, atomoxetine treatment was associated with changes of TUNEL, pCREB, and BDNF expression levels, and microglial numbers, morphology, and responses.

Pretreatment with magnesium sulfate attenuates white matter damage by preventing cell death of developing oligodendrocytes

AIM

Antenatal maternal administration of magnesium sulfate (MgSO₄ ) reduces cerebral palsy in preterm infants. However, it remains controversial as to whether it also reduces occurrence of white matter damage, or periventricular leukomalacia. We assessed the effect of MgSO₄ against white matter damage induced by hypoxic-ischemic insult using a neonatal rat model and culture of premyelinating oligodendrocytes (pre-OL).

METHODS

Rat pups at postnatal day (P) 6 were administered either MgSO₄ or vehicle intraperitoneally before hypoxic-ischemic insult (unilateral ligation of the carotid artery followed by 6% oxygen for 1 h). The population of oligodendrocyte (OL) markers and CD-68-positive microglia at P11, and TdT-mediated biotin-16-dUTP nick-end labeling (TUNEL)-positive cells at P8 were evaluated in pericallosal white matter. Primary cultures of mouse pre-OL were subjected to oxygen glucose deprivation condition, and the lactate dehydrogenase release from culture cells was evaluated to assess cell viability.

RESULTS

Pretreatment with MgSO₄ attenuated the loss of OL markers, such as myelin basic protein and Olig2, in ipsilateral pericallosal white matter and decreased the number of CD-68-positive microglia and TUNEL-positive cells in vivo. Pretreatment with MgSO₄ also inhibited lactate dehydrogenase release from pre-OL induced by oxygen glucose deprivation in vitro.

CONCLUSION

Pretreatment with MgSO₄ attenuates white matter damage by preventing cell death of pre-OL.

Crystallographic and electronic properties of AlCrN films that absorb visible light

We investigate the crystallographic and electronic properties of wurtzite Cr-doped AlN (AlCrN) films (Cr ≤12.0%) that absorb visible light. We confirmed that the films consist of wurtzite columnar single crystals that are densely packed, c-axis oriented, and exhibit a random rotation along the a-axis in plane by using transmission electron microscopy. The oxidation state of Cr was found to be 3+ using Cr K-edge X-ray absorption near edge structure, which implies that Cr can be a substitute for Al3+ in AlN. The first nearest neighbor distances estimated using Cr K-edge extended X-ray absorption fine structure (EXAFS) were found to be nearly isotropic for incident light with electric fields that are parallel and perpendicular to the plane. The results of ab initio lattice relaxation calculations for the model of wurtzite Al1-xCrxN supercell where Cr replaces Al support the EXAFS results. The calculations for the model showed that additional energy bands are formed in the band gap of AlN, in which the Fermi energy (EF ) is present. As expected from the calculation results, the electrical conductivity increases with increase in the Cr concentration, implying that the density of states at EF increases monotonically. From these results, we can conclude that AlCrN films are an intermediate band material with respect to their crystallographic and electric properties.

Electronic structure of AlCrN films investigated using various photoelectron spectroscopies and ab initio calculations

The valence band (VB) structures of wurtzite AlCrN (Cr concentration: 0-17.1%), which show optical absorption in the ultraviolet-visible-infrared light region, were investigated via photoelectron yield spectroscopy (PYS), x-ray/ultraviolet photoelectron spectroscopy (XPS/UPS), and ab initio density of states (DOS) calculations. An obvious photoelectron emission threshold was observed ~5.3 eV from the vacuum level for AlCrN, whereas no emission was observed for AlN in the PYS spectra. Comparisons of XPS and UPS VB spectra and the calculated DOS imply that Cr 3d states are formed both at the top of the VB and in the AlN gap. These data suggest that Cr doping could be a viable option to produce new materials with relevant energy band structures for solar photoelectric conversion.

Central bisectionectomy for hepatocellular carcinoma in a patient with indocyanine green excretory defect associated with reduced expression of the liver transporter

Background

Indocyanine green (ICG) excretory defect is a dye excretory disorder, and it is characterized by the selective impairment of plasma ICG clearance with normal liver histology. The pathophysiology involves selective loss of active transporters for ICG in the hepatic cell membrane. Several cases of hepatectomy in patients with ICG excretory defect have been reported, but the expression of hepatic transporters involved in ICG excretory defect has not been examined in these cases.

Case presentation

An 81-year-old man who was hepatitis B and C virus negative was admitted to our hospital with a diagnosis of HCC. Abdominal computed tomography revealed an 8-cm-diameter tumor in hepatic segments 4 and 8. The retention rate of ICG at 15 min (ICGR₁₅), which has been used to evaluate hepatic functional reserve, was markedly elevated (79.1 %), whereas other liver function test results, were normal. Therefore, we diagnosed the patient with HCC with an ICG excretory defect, and considered major hepatectomy. Central bisectionectomy was performed, and the postoperative course was uneventful. Microscopic examination of the resected specimen showed moderately differentiated HCC. Immunohistochemical staining and polymerase chain reaction analysis of a non-neoplastic site of the resected specimen showed very few expression of the organic anion-transporting polypeptide 1B3 (OATP1B3), which is usually expressed on the basolateral membrane of human hepatocytes and mediates the uptake of ICG.

Conclusions

In this case, we present a case of hepatectomy for HCC in a patient with ICG excretory defect, which may be attributable to a congenital disorder of OATP1B3 expression; however, an ICG excretory defect did not seem to have any effect on the short-term prognosis after hepatectomy.

Promotion of Intestinal Epithelial Cell Turnover by Commensal Bacteria: Role of Short-Chain Fatty Acids

The life span of intestinal epithelial cells (IECs) is short (3–5 days), and its regulation is thought to be important for homeostasis of the intestinal epithelium. We have now investigated the role of commensal bacteria in regulation of IEC turnover in the small intestine. The proliferative activity of IECs in intestinal crypts as well as the migration of these cells along the crypt-villus axis were markedly attenuated both in germ-free mice and in specific pathogen–free (SPF) mice treated with a mixture of antibiotics, with antibiotics selective for Gram-positive bacteria being most effective in this regard. Oral administration of chloroform-treated feces of SPF mice to germ-free mice resulted in a marked increase in IEC turnover, suggesting that spore-forming Gram-positive bacteria contribute to this effect. Oral administration of short-chain fatty acids (SCFAs) as bacterial fermentation products also restored the turnover of IECs in antibiotic-treated SPF mice as well as promoted the development of intestinal organoids in vitro. Antibiotic treatment reduced the phosphorylation levels of ERK, ribosomal protein S6, and STAT3 in IECs of SPF mice. Our results thus suggest that Gram-positive commensal bacteria are a major determinant of IEC turnover, and that their stimulatory effect is mediated by SCFAs.

Ce electronic states in Nd(0.45-x)Ce(x)Sr0.55MnO3 probed by x-ray absorption spectroscopy and photoemission

We have investigated the Ce 4f electronic states in the Ce-doped manganites Nd(0.45-x)Ce(x)Sr0.55MnO3 (NCSMO) by means of x-ray absorption spectroscopy (XAS) and hard x-ray photoelectron spectroscopy (HAXPES). The Ce 3d XAS shows that the Ce ions exist in the form of the Ce(3+) and Ce(4+) mixed-valent states, and we have found that the XAS spectral features change with temperature. The Ce 3d XAS and HAXPES spectra for NCSMO agree reasonably well with calculated results based on the single-impurity Anderson model, which takes into account the atomic multiplets and two valence bands. The estimated Ce bulk valence of Nd0.15Ce0.3Sr0.55MnO3 decreases from 3.44 to 3.30 with cooling.

Inferior vena cava tumor thrombus that directly infiltrated from paracaval lymph node metastases in a patient with recurrent hepatocellular carcinoma

Herein, we present the case of a patient with recurrent hepatocellular carcinoma (HCC) who had paracaval lymph node (LN) metastases with an inferior vena cava (IVC) tumor thrombus after a hepatectomy. A 65-year-old man with chronic hepatitis B virus infection received an extended anterior segmentectomy because of two hepatic tumors, located in segments 7 and 8. Histological examination of both resected specimens showed mostly moderately differentiated HCC with some poorly differentiated areas, and liver cirrhosis (A2/F4). Because the patient had an elevated α-fetoprotein serum level, abdominal computed tomography (CT) was performed. Abdominal CT revealed a 9-mm-diameter recurrent tumor in hepatic segment 3 and paracaval LN metastases with an IVC tumor thrombus at 8 months after the first operation. The patient received transcatheter arterial chemoembolization as treatment for the intrahepatic recurrence, following resection of the paracaval LN metastases and removal of the IVC tumor thrombus. In this case, the paracaval LN metastases had directly infiltrated the IVC via the lumbar veins, resulting in an IVC tumor thrombus, which usually develops from an intrahepatic tumor via the hepatic vein. The development of an IVC tumor thrombus with HCC recurrence, as in this case, is very rare, and based on a PubMed search, we believe this report may be the first to describe this condition.

Efficacy of subcutaneous penrose drains for surgical site infections in colorectal surgery

AIM: To investigate whether a subcutaneous penrose drain would decrease the superficial surgical site infection (s-SSI) rate in elective colorectal surgery.

METHODS: This is a comparative study of the historical control type. Intervention consisted of the use of penrose drain in elective open colorectal surgical wounds. The outcome was an incidence of s-SSI. The patients were risk stratified according to the depth of subcutaneous tissue.

RESULTS: There were 131 patients (40 patients with high s-SSI risk) in the prior period (from July 2008 to June 2009, when no penrose drains were inserted) and 151 patients (75 patients with high s-SSI risk) in the latter period (from June 2010 to November 2011, when penrose drains were inserted). The overall s-SSI rate was 6.1% and 5.3% during the two periods (P = 0.770), and the s-SSI rate in the high s-SSI risk group was 15.0% and 8.0% (P = 0.242).

CONCLUSION: Although penrose drain was not observed to significantly reduce s-SSI, there tended to be a reduced risk of s-SSI in the high s-SSI risk group.

[A case of rectal cancer with long-term disease-free survival following resection of the right iliac artery due to isolated para-aortic lymph node recurrence]

A 79-year-old man was diagnosed with infrarenal abdominal aortic aneurysm extending to the right common iliac artery and rectal cancer. He underwent a Y graft replacement for abdominal aortic aneurysm and an anterior resection for rectal cancer after 1 month. No adjuvant therapy was performed. Eleven months after the operation to remove the rectal cancer, computed tomography examination revealed isolated para-aortic lymph node recurrence. The mass involved the right bundle branch of the synthetic graft and the right external and internal iliac artery. Therefore, we resected the area from the right bundle branch of the synthetic graft to the right external and internal iliac artery en bloc. Pathological examination of the resected specimen showed metastatic adenocarcinoma. No additional therapy was performed. As of 10 years after the second operation, the patient is alive and recurrence free. Isolated aortic lymph node recurrence may be cured by resection; hence, surgical resection should be considered if possible.

Recurrence of hepatocellular carcinoma presenting as an asymptomatic appendiceal tumor: report of a case

This report presents the case of a 66-year-old male with appendicular metastasis from hepatocellular carcinoma. He had a clinical history of right lobectomy of the liver after the diagnosis of hepatocellular carcinoma 3 years prior, and was admitted because of an asymptomatic appendiceal tumor detected by computed tomography. The appendiceal tumor was preoperatively suspected to be a recurrence of hepatocellular carcinoma, because of the patient's elevated level of serum α-fetoprotein and protein induced by vitamin K absence or antagonist II, and based on the magnetic resonance imaging findings. An appendectomy was thus performed, and the histopathological findings confirmed the diagnosis of a metastatic tumor from hepatocellular carcinoma. Appendicular metastasis is extremely rare. This is only the second case of a metastatic appendiceal tumor from hepatocellular carcinoma reported in the English literature.

Prenatal diagnosis and management of congenital chloride diarrhea: A case report of 2 siblings

Congenital chloride diarrhea (CLD) is a rare hereditary disease. The basic defect of CLD is massive loss of Cl(-) and fluid into the ileum and colon. Prenatal diagnosis of this disease is quite important because the infant requires electrolyte supplementation from the early postnatal period. Two cases in which prenatal diagnoses of CLD were made in siblings are reported. Extreme electrolyte imbalance may cause fetal cardiac dysfunction or a poor general condition leading to a non-reassuring fetal status in cases with CLD. Therefore, frequent fetal monitoring using cardiotocograms and ultrasound may be beneficial to some fetuses with CLD to detect fetal deterioration. In addition, repeated amnioreduction may be required to treat severe polyhydramnios and threatened preterm delivery.

A case of pyruvate dehydrogenase E1α subunit deficiency with antenatal brain dysgenesis demonstrated by prenatal sonography and magnetic resonance imaging

Prenatal depiction of brain dysgenesis in patients with pyruvate dehydrogenase complex (PDHc) deficiencies has been infrequently reported. As PDHc plays a critical role in the brain that obtains all of the energy from the aerobic oxidation of glucose, its deficiency is a severe inborn disorder of metabolism, which predominantly affects the nervous system. This report describes a case of PDHc deficiency with antenatal brain dysgenesis depicted in detail by fetal ultrasound and magnetic resonance imaging. This is the first case report clearly demonstrating the developing mechanism and time course of antenatal brain lesions in a patient with PDHc deficiency.

Transplacental fetal therapy for junctional ectopic tachycardia

Junctional ectopic tachycardia (JET) is a rare type of tachyarrhythmia. A 39-year-old woman was transferred to our hospital for fetal tachyarrhythmia at 32 weeks' gestation. Fetal cardiac sonography revealed atrial and ventricular rates of 120-130 and 175-230 bpm, respectively, without 1:1 atrioventricular relationship. As ventricular tachycardia was considered to be the most probable diagnosis, transplacental therapy with digoxin and sotalol was done with partial response. Diagnosis of JET was made after birth. Although fetal JET is rare and prenatal diagnosis and treatment of this condition is still a challenge, differential diagnosis of fetal tachyarrhythmia should include this disorder.

Brain metastasis from colorectal cancer: prognostic factors and survival

BACKGROUND

Colorectal cancer (CRC) rarely metastasizes to the brain, and the incidence rate has been reported to be 1-2%. Unfortunately, the median survival for patients with brain metastasis (BM) from CRC is short. In this study, we retrospectively investigated the BM from CRC and examined the prognostic factors.

METHODS

We retrospectively analyzed 29 CRC patients who developed BM; the lesions were diagnosed synchronously in 1 patient and metachronously in 28 patients.

RESULTS

After BM, the median survival time was 7.4 months. In the groups of patients who underwent surgical resection and radiation therapy, the median survival times were 8.3 and 7.4 months, respectively. The difference between the two groups was not statistically significant. The curability of the therapy for BM, number of BM, number of metastatic organs including the brain, and the CEA level at the time of treatment of the BM were significantly associated with the cancer-specific survival (P = 0.0044, 0.0229, 0.0019, and 0.0205, respectively).

CONCLUSIONS

The prognosis of patients with BM from CRC was associated with the curability of the therapy for BM, number of metastatic organs, and the serum CEA level. The modality of treatment had no significant impact on the outcome.

[A case of perianal squamous cell carcinoma attaining a complete response over five years with chemoradiotherapy]

We report a case with perianal squamous cell carcinoma, which showed a complete response more than five years after chemoradiotherapy. A 69-year-old-man was introduced to our hospital for the diagnosis of squamous cell carcinoma [T3 (8.0 × 8.0 cm) N0M0, Stage II]. The patient was treated by chemoradiotherapy, which consisted of 5-FU 750 mg/m²/ day (continuous intravenously) on days 1-5 and 29-33, and mitomycin C 10 mg/m² on days 1 and 29 and radiation at 2 Gy/day for 5 days per week (total dose 60 Gy). The patient tolerated this treatment with no severe adverse effects. Tumor disappeared completely 1 month after this treatment with no adjuvant therapy. The patient has been alive with no sign of recurrence for 6 years.

Hypothermia-induced increase of oligodendrocyte precursor cells: Possible involvement of plasmalemmal voltage-dependent anion channel 1

Hypothermia is believed to suppress cell proliferation by inducing apoptosis/necrosis and phase-specific/nonspecific cell cycle arrest, which are, directly or indirectly, related to a reduced energy supply. Intriguingly, hypothermia is known to improve neurological recovery of animals and humans exposed to focal brain hypoxic-ischemic injury. The underlying mechanism of the neuroprotective effect of hypothermia is unclear, although the prevention of neural cell apoptosis is thought to play a role. Herein we demonstrate that in vitro cell culture of oligodendrocyte precursor cells (OPCs) under conditions of mild hypothermia (31.5°C) results in an increase in cell number relative to cells cultured under normothermic conditions (37°C). Cell cycle analysis, immunoblotting of cyclins, TUNEL assay, and immunocytochemistry of OPC differentiation markers suggest that hypothermia shifts the balance between proliferation and apoptosis/differentiation toward proliferation. A combination of transcriptome analysis, pharmacological intervention, and immunoaffinity-based assays suggests a possible involvement of the Gα13-Rho GTPase Cdc42-ERK1/2 signaling cascade and voltage-dependent anion channel 1 (VDAC1), which associate or dissociate with Gα13 protein at 37°C and 31.5°C, respectively. Immunoelectron microscopy revealed the presence of VDAC1 in the plasma membrane of OPCs. Furthermore, the exogenous addition of impermeable VDAC1 inhibitors enhanced proliferation of OPCs at 37°C. These results may contribute to the elucidation of the mechanism of hypothermic neuroprotection as well as the possible novel role of plasmalemmal VDAC1.

Coexistence of strongly mixed-valence and heavy-fermion character in SmOs4Sb12 studied by soft- and hard-X-ray spectroscopy

Sm-based heavy-fermion compound SmOs4Sb12 has been investigated by soft x-ray (hnu=1070-1600 eV) and hard x-ray (HX; hnu=7932 eV) spectroscopy. The HX photoemission spectroscopy clearly demonstrates that the strongly mixed-valence state and the heavy-fermion state coexist in the bulk. It is found that the Sm valence decreases below 100 K, indicating that the Kondo coherence develops with approaching the proposed Kondo temperature. Our theoretical analyses suggest that the origin of the coexistence in SmOs4Sb12 is the coincidence of two conditions, namely, (i) the energy difference between Sm divalent and trivalent states is very small and (ii) the hybridization between Sm 4f and conduction electrons is weak.

Three-dimensional bulk fermiology of CeRu2Ge2 in the paramagnetic phase by soft x-ray hnu-dependent (700-860 eV) ARPES

By virtue of the soft x-ray angle-resolved photoelectron spectroscopy, the three-dimensional bulk fermiology has been successfully performed for a strongly correlated Ce compound, ferromagnet CeRu2Ge2 in the paramagnetic phase. A clear difference of the Fermi surface topology from either band calculation or de Haas-van Alphen results in the ferromagnetic phase is observed and interpreted by considering the difference of the 4f contribution to the Fermi surfaces in the paramagnetic phase.

Mutual experimental and theoretical validation of bulk photoemission spectra of Sr1-xCaxVO3

We report high-resolution high-energy photoemission spectra together with parameter-free LDA + DMFT (local density approximation + dynamical mean-field theory) results for Sr1-xCaxVO3, a prototype 3d(1) system. In contrast to earlier investigations the bulk spectra are found to be insensitive to x. The good agreement between experiment and theory confirms the bulk sensitivity of the high-energy photoemission spectra.

Localized character of 4f electrons in CeRhx (x=2,3) and CeNix (x=2,5)

We have measured Ce 4f spectral weights of extremely alpha-like Ce transition metal intermetallic compounds CeRhx (x=2,3) and CeNix (x=2,5) by using the bulk-sensitive resonant photoemission technique at the Ce M5(3d(5/2)-->4f) edge. High energy resolution and longer escape depth of photoemitted electron at this photon energy enabled us to distinguish the sharp Kondo resonance tails at the Fermi level, which can be well described by the Gunnarsson-Schönhammer calculation based on the Anderson impurity Hamiltonian. On the other hand, the itinerant 4f band description shows big discrepancies, which implies that Ce 4f electrons retain localized characters even in extremely alpha-like compounds.

Contrast effect in evaluating palatability of beverages

This study aimed to clarify the contextual effect in evaluation of the pleasantness of beverages. Participants were presented a test stimulus and were then asked to rate how much they liked it before and after presentation of a contextual stimulus. Specifically, after participants were exposed to a less palatable beverage, they evaluated the test beverage as being more palatable than when their judgment of a test drink occurred after presentation of a neutral or palatable beverage (a positive contrast effect). This contextual effect can be explained by the reasoning that participants were affectively adapted to the palatability (less palatable) of a less palatable stimulus after repeated exposure; thus, they evaluated the test stimulus as more palatable. This study suggests that the evaluated value of the contextual stimuli affects evaluation of the test stimulus. The authors also suggest that these context effects are probably found in everyday life.

Enhancement of sweetness ratings of aspartame by a vanilla odor presented either by orthonasal or retronasal routes

When taste stimuli are presented with specific odor stimuli, the perceived intensity of taste is enhanced, a phenomenon called odor-induced taste enhancement. There is a possibility, however, that the odor substances might have stimulated the taste receptors in the oral cavity as well as odor receptors in the nasal cavity because the odor substances were dissolved in the taste solutions in some preceding studies. Schifferstein and Verlegh (1996) found that the odor-induced taste enhancement effect was not found when the subjects wore a nose clip to prevent the olfactory perception. Thus, it was suggested that the odor-induced taste enhancement did not result from the stimulation of receptors in the oral cavity. To confirm and extend their study, we presented the odor stimuli simultaneously with, but not dissolved in, the taste stimuli with a more advanced approach to stimulus presentation. The participants reported enhancement of sweetness ratings for aspartame when the taste stimuli were presented with a vanilla odor. This odor induced taste enhancement was found when the gaseous odor stimuli were presented either by the retronasal route or by the orthonasal route. There was little possibility that the vanilla odor stimulated the taste receptors during the orthonasal stimulation because the odor stimuli were presented directly into the nasal cavity. Thus, we could show that the odor-induced taste enlancement is elicited by olfactory perception. These results also suggested that there is little functional difference between retronasal and orthonasal olfaction.

Magnetic circular dichroism at transition metal L2,3 edges in D03-type (Fe(1-x)Vx)3Al alloys

Magnetic circular dichroism (MCD) spectra have been measured at the Fe and V L2,3 edges of DO3-type (Fe(1-x)Vx)3Al in order to investigate their local magnetic moments and electronic structures. Large MCD is observed at the Fe L2,3 edges, while the V L2,3 MCD shows relatively small intensity with complicated features. Signs of these MCD spectra indicate an antiferromagnetic coupling between the magnetic moments on Fe and V. According to the analysis based on the magneto-optical sum rules, the magnetic moment decreases with x, but remains fairly large for Fe2VAl, which might arise from its marginally magnetic nature.

High-resolution soft X-ray absorption spectroscopy of solids

The present research deals with the high-resolution soft x-ray absorption spectra (XAS) of Si, Ce- and Sm- compounds measured at BL25SU of SPring-8. The spectra are compared with theoretical results. The Si 1s spectrum shows good agreement with the calculated empty density of states so far reported. The Ce 3d spectra are very sensitive to the local electronic structure. The Sm 3d XAS of SmS shows clear temperature dependence, which is partly explained by a calculation for Sm2+ ion.

Magnetic circular dichroism at transition metal L2,3 edges in D03-type (Fe(1-x)Mn(x))3Al alloys

We have measured magnetic circular dichroism (MCD) spectra at the transition-metal L2,3 edges in D03-type (Fe(1-x)Mn(x))3Al in order to investigate their local magnetic moments. The analysis of the spectra shows that Fe has moments much larger than Mn, whose moment is ferromagnetically coupled with the Fe one. This does not lend support to the antiferromagnetic mechanism proposed for the reduction in magnetization as well as a large Mn moment predicted for x = 1/3. The evolution of satellites found in the Mn spectrum with x increased suggests that the change in the electronic state may result in the magnetization reduction.

Attitudes to food and the role of food in life in the U.S.A., Japan, Flemish Belgium and France: possible implications for the diet-health debate

For human beings, food is a critical contributor to physical well being, a major source of pleasure, worry and stress, a major occupant of waking time and, across the world, the single greatest category of expenditures. This is a first study of the way food functions in the minds and lives of people from four cultures. Adults and college students from Flemish Belgium, France, U.S.A. and Japan were surveyed with questions dealing with beliefs about the diet-health link, worry about food, the degree of consumption of foods modified to be "healthier" (e.g. reduced in salt or fat), the importance of food as a positive force in life, the tendency to associate foods with nutritional vs. culinary contexts, and satisfaction with the healthiness of one's own diet. In all domains except beliefs about the importance of diet for health, there are substantial country (and usually gender) differences. Generally, the group associating food most with health and least with pleasure is the Americans, and the group most food-pleasure-oriented and least food-health-oriented is the French. In all four countries, females, as opposed to males, show a pattern of attitudes that is more like the American pattern, and less like the French pattern. In either gender, French and Belgians tend to occupy the pleasure extreme, Americans the health extreme, with the Japanese in between. Ironically, the Americans, who do the most to alter their diet in the service of health, are the least likely to classify themselves as healthy eaters. We conclude that there are substantial cross-cultural differences in the extent to which food functions as a stressor vs. a pleasure. These differences may influence health and may partially account for national differences in rates of cardiovascular diseases (the "French paradox").

The CAD triad hypothesis: a mapping between three moral emotions (contempt, anger, disgust) and three moral codes (community, autonomy, divinity)

It is proposed that 3 emotions--contempt, anger, and disgust--are typically elicited, across cultures, by violations of 3 moral codes proposed by R. A. Shweder and his colleagues (R. A. Shweder, N. C. Much, M. Mahapatra, & L. Park, 1997). The proposed alignment links anger to autonomy (individual rights violations), contempt to community (violation of communal codes including hierarchy), and disgust to divinity (violations of purity-sanctity). This is the CAD triad hypothesis. Students in the United States and Japan were presented with descriptions of situations that involve 1 of the types of moral violations and asked to assign either an appropriate facial expression (from a set of 6) or an appropriate word (contempt, anger, disgust, or their translations). Results generally supported the CAD triad hypothesis. Results were further confirmed by analysis of facial expressions actually made by Americans to the descriptions of these situations.

The CAD triad hypothesis: a mapping between three moral emotions (contempt, anger, disgust) and three moral codes (community, autonomy, divinity)

It is proposed that 3 emotions--contempt, anger, and disgust--are typically elicited, across cultures, by violations of 3 moral codes proposed by R. A. Shweder and his colleagues (R. A. Shweder, N. C. Much, M. Mahapatra, & L. Park, 1997). The proposed alignment links anger to autonomy (individual rights violations), contempt to community (violation of communal codes including hierarchy), and disgust to divinity (violations of purity-sanctity). This is the CAD triad hypothesis. Students in the United States and Japan were presented with descriptions of situations that involve 1 of the types of moral violations and asked to assign either an appropriate facial expression (from a set of 6) or an appropriate word (contempt, anger, disgust, or their translations). Results generally supported the CAD triad hypothesis. Results were further confirmed by analysis of facial expressions actually made by Americans to the descriptions of these situations.

Neutropenic colitis as a complication of high-dose chemotherapy for refractory testicular cancer

A 44-year-old man received high-dose chemotherapy with carboplatin, etoposide and cyclophosphamide followed by autologous peripheral-blood stem-cell transplantation for treatment of refractory nonseminomatous testicular cancer (seminoma plus choriocarcinoma). The patient developed fever, watery diarrhea and abdominal pain at 10 days after the initiation of high-dose chemotherapy. Radiological examinations revealed adynamic ileus with thickened colon and small bowel wall and increasing ascites over the next 3 days. The patient subsequently suffered from disseminated intravascular coagulation, renal failure and hyperbilirubinemia despite systemic antibiotic therapy. Intensive medical care could barely avoid the fatal outcome. Neutropenic colitis has been recognized as a complication of acute leukemia or aplastic anemia. The present case indicates that this serious gastrointestinal complication can occur under profound neutropenic conditions induced by intensive chemotherapy for solid cancer.

Evaluation of tapered-end toothbrushes regarding subgingival access efficacy

The purpose of this in vitro study was to determine how two toothbrushes with highly tapered-end bristle designs compared to a conventional, slightly tapered toothbrush. Toothbrushing was carried out in the laboratory in order to evaluate the simulated subgingival efficacy of the three toothbrush designs. The performance of the three brushes was assessed by measuring the "subgingival regions" of gold-coated typodont left maxillary central teeth where the gold coating had been removed during brushing. The two toothbrushes with highly tapered bristles were statistically significantly (p < 0.01) more effective in removing the gold coating than the conventional toothbrush with slightly tapered bristles on the subgingival area on the anterior typodont teeth.