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1.  Fibrin membrane pupillary-block glaucoma after uneventful cataract surgery treated with intracameral tissue plasminogen activator: a case report 
BMC Ophthalmology  2012;12:3.
Fibrin pupillary-block glaucoma is a rare complication after cataract surgery. The treatment for this condition is still controversial, since Nd:YAG laser fibrin membranotomy tends to reocclude and laser peripheral iridotomy entails the risk of damaging the corneal endothelium in the presence of corneal edema associated with elevated intraocular pressure.
Case presentation
A 62-year-old man with diabetes mellitus developed acute elevation of intraocular pressure with a shallow anterior chamber five days after uneventful cataract surgery. Initially, slit lamp examination provided only limited information due to severe corneal edema. After resolution of corneal edema with systemic glaucoma therapy, a complete fibrin membrane was observed across the pupil by slit lamp examination. Anterior segment optic coherence tomography clearly revealed a thin fibrin membrane covering the entire pupillary space, a shallow anterior chamber, and a deep posterior chamber. The intraocular lens was not observed by anterior segment optic coherence tomography. In contrast, ultrasound biomicroscopy, which has superior penetration depth, was able to visualize the intraocular lens deep in the posterior chamber. Injection of tissue plasminogen activator into the anterior chamber resulted in complete fibrinolysis and released the pupillary block.
This case suggests that ocular anterior segment imaging modalities, especially ultrasound biomicroscopy, serve as powerful diagnostic tools to identify mechanisms of acute angle closure glaucoma, which is often accompanied by poor intraocular visibility. This is the first reported case of fibrin pupillary-block glaucoma after cataract surgery successfully treated with intracameral tissue plasminogen activator.
PMCID: PMC3326710  PMID: 22433746
Pupillary block glaucoma; Fibrin membrane; Cataract surgery; Anterior segment imaging; Tissue plasminogen activator
2.  Randomized Phase III Trial of Adjuvant Chemotherapy with S-1 after Curative Treatment in Patients with Squamous-Cell Carcinoma of the Head and Neck (ACTS-HNC) 
PLoS ONE  2015;10(2):e0116965.
We conducted a phase III study to evaluate S-1 as compared with UFT as control in patients after curative therapy for stage III, IVA, or IVB squamous-cell carcinoma of the head and neck (SCCHN).
Patients and Methods
Patients were randomly assigned to the UFT group (300 or 400 mg day-1 for 1 year) or the S-1 group (80, 100, or 120 mg day-1 for 1 year). The primary end point was disease-free survival (DFS). Secondary end points were relapse-free survival, overall survival (OS), and safety.
A total of 526 patients were enrolled, and 505 were eligible for analysis. The 3-year DFS rate was 60.0% in the UFT group and 64.1% in the S-1 group (HR, 0.87; 95%CI, 0.66-1.16; p = 0.34). The 3-year OS rate was 75.8% and 82.9%, respectively (HR, 0.64; 95% CI, 0.44-0.94; p = 0.022). Among grade 3 or higher adverse events, the incidences of leukopenia (5.2%), neutropenia (3.6%), thrombocytopenia (2.0%), and mucositis/stomatitis (2.4%) were significantly higher in the S-1 group.
Although DFS did not differ significantly between the groups, OS was significantly better in the S-1 group than in the UFT group. S-1 is considered a treatment option after curative therapy for stage III, IVA, IVB SCCHN.
Trial Registration NCT00336947
PMCID: PMC4324826  PMID: 25671770
3.  Enhancement of glycerol metabolism in the oleaginous marine diatom Fistulifera solaris JPCC DA0580 to improve triacylglycerol productivity 
Microalgal oil is a promising alternative feedstock for biodiesel fuel (BDF). Mixotrophic cultivation with glycerol, the primary byproduct of BDF production, may be used to optimize BDF production. This strategy would reduce costs through glycerol recycling and improve lipid productivity and biomass productivity by overcoming the growth retardation caused by decreased light penetration in high-density culture.
Overexpression of the endogenous glycerol kinase (GK) gene in an oleaginous marine diatom, Fistulifera solaris JPCC DA0580, accelerates glycerol metabolism and improves lipid and biomass productivities. Two candidates were selected from a collection of 90 G418-resistant clones, based on growth and confirmation of genome integration. GK gene expression was higher in the selected clones (GK1_7 and GK2_16) than in the wild-type culture. The GK2_16 clone achieved a 12% increase in lipid productivity.
We have demonstrated the potential of metabolic engineering in oleaginous microalgae to improve lipid productivity. Metabolic engineering techniques can be used to optimize BDF production.
Electronic supplementary material
The online version of this article (doi:10.1186/s13068-014-0184-9) contains supplementary material, which is available to authorized users.
PMCID: PMC4308894  PMID: 25632299
Oleaginous microalgae; Fistulifera solaris; Mixotrophic cultivation; Glycerol kinase; Biodiesel fuel; Metabolic engineering
4.  Lethal effects of short-wavelength visible light on insects 
Scientific Reports  2014;4:7383.
We investigated the lethal effects of visible light on insects by using light-emitting diodes (LEDs). The toxic effects of ultraviolet (UV) light, particularly shortwave (i.e., UVB and UVC) light, on organisms are well known. However, the effects of irradiation with visible light remain unclear, although shorter wavelengths are known to be more lethal. Irradiation with visible light is not thought to cause mortality in complex animals including insects. Here, however, we found that irradiation with short-wavelength visible (blue) light killed eggs, larvae, pupae, and adults of Drosophila melanogaster. Blue light was also lethal to mosquitoes and flour beetles, but the effective wavelength at which mortality occurred differed among the insect species. Our findings suggest that highly toxic wavelengths of visible light are species-specific in insects, and that shorter wavelengths are not always more toxic. For some animals, such as insects, blue light is more harmful than UV light.
PMCID: PMC4260232  PMID: 25488603
6.  Altered sphingoid base profiles predict compromised membrane structure and permeability in atopic dermatitis 
Journal of dermatological science  2013;72(3):10.1016/j.jdermsci.2013.08.003.
Ceramide hydrolysis by ceramidase in the stratum corneum (SC) yields both sphingoid bases and free fatty acids (FFA). While FFA are key constituents of the lamellar bilayers that mediate the epidermal permeability barrier, whether sphingoid bases influence permeability barrier homeostasis remains unknown. Pertinently, alterations of lipid profile, including ceramide and ceramidase activities occur in atopic dermatitis (AD).
We investigated alterations in sphingoid base levels and/or profiles (sphingosine to sphinganine ratio) in the SC of normal vs. AD mice, a model that faithfully replicates human AD, and then whether altered sphingoid base levels and/or profiles influence(s) membrane stability and/or structures.
Unilamellar vesicles (LV), incorporating the three major SC lipids (ceramides/FFA/cholesterol) and different ratios of sphingosine/sphinganine, encapsulating carboxyfluorescein, were used as the model of SC lipids. Membrane stability was measured as release of carboxyfluorescein. Thermal analysis of LV was conducted by Differential scanning calorimetry (DSC).
LV containing AD levels of sphingosine/sphinganine (AD-LV) displayed altered membrane permeability vs. normal-LV. DSC analyses revealed decreases in orthorhombic structures that form tightly-packed lamellar structures in AD-LV.
Sphingoid base composition influences lamellar membrane architecture in SC, suggesting that altered sphingoid base profiles could contribute to the barrier abnormality in AD.
PMCID: PMC3866955  PMID: 24070864
atopic dermatitis; barrier; ceramide; sphingosine
7.  Effect on Intraocular Pressure of Switching from Latanoprost and Travoprost Monotherapy to Timolol Fixed Combinations in Patients with Normal-Tension Glaucoma 
Journal of Ophthalmology  2014;2014:720385.
Purpose. To evaluate the effect on intraocular pressure (IOP) of switching from latanoprost and travoprost monotherapy to timolol fixed combinations in Japanese patients with normal-tension glaucoma (NTG). Methods. 27 NTG patients (54 eyes) were compared IOP, superficial punctuate keratitis (SPK) scores, and conjunctival injection scores in eyes treated with prostaglandin (PG) or PG analog/beta-blocker (PG/b) fixed-combination 6 months after the change in therapy. Results. The mean baseline intraocular pressure was 17.4 ± 1.59 mmHg in eyes receiving PG therapy only and 17.4 ± 1.69 mmHg in eyes switched to PG/b. Switching to fixed combination therapy from PG monotherapy, the mean IOP was 13.1 ± 1.79 mmHg (P < 0.001)  (−24.71% reduction from baseline) at 6 months. The mean conjunctival injection score was 0.69 for eyes on PG monotherapy and 0.56 for eyes on fixed combination therapy (P = 0.028). The mean SPK scores were 0.46 and 0.53. This difference was not statistically significant (P = 0.463). Conclusions. Switching from PG monotherapy to PG/b fixed combination therapy for NTG resulted in a greater intraocular pressure reduction than PG alone without increasing the number of instillations.
PMCID: PMC4258362  PMID: 25505978
8.  Unique expression features of cancer-type organic anion transporting polypeptide 1B3 mRNA expression in human colon and lung cancers 
We have previously identified the cancer-type organic anion transporting polypeptide 1B3 (Ct-OATP1B3) mRNA in several human colon and lung cancer tissues. Ct-OATP1B3 is a variant of the liver-type OATP1B3 (Lt-OATP1B3) mRNA, which is a hepatocyte plasma membrane transporter with broad substrate specificity. However, in cancer tissues, both the detailed characteristics of Ct-OATP1B3 mRNA expression and its biological functions remain unclear. With this point in mind, we sought to characterize Ct-OATP1B3 mRNA expression in colon and lung cancer tissues. In addition, we attempted to obtain functional implication of Ct-OATP1B3 in cancer cells.
Matched pairs of cancer and normal tissues were collected from 39 colon cancer and 28 lung cancer patients. The OATP1B3 mRNA expression levels in each of these tissues were separately determined by quantitative real-time polymerase chain reaction. Mann–Whitney U test and Fisher’s exact test were used in statistical analysis. The Ct-OATP1B3 functional expression in colon cancer cells was then examined by Western blotting and transport analyses.
Ct-OATP1B3 mRNA, but not Lt-OATP1B3 mRNA, was abundantly expressed in colon cancer tissues at a higher detection frequency (87.2%) than that of the adjacent normal tissues (2.6%). Furthermore, it was found that Ct-OATP1B3 mRNA expression was often detected in early colon cancer stages (88.9%, n = 18), and that its expression was associated with well-differentiated colon cancer statuses. On the other hand, Ct-OATP1B3 mRNA also showed a predominant and cancer-associated expression profile in lung tissues, although at frequencies and expression levels that were lower than those obtained from colon cancer. As for attempts to clarify the Ct-OATP1B3 functions, neither protein expression nor transport activity could be observed in any of the cell lines examined.
Based on the unique characteristics of the Ct-OATP1B3 mRNA expression profile identified in this study, Ct-OATP1B3 mRNA can be expected to become a biomarker candidate for use in colon (and lung) cancer diagnosis. Simultaneously, our results advance the possibility that Ct-OATP1B3 might play yet unidentified roles, in addition to transporter function, in cancer cell biology.
PMCID: PMC4298695  PMID: 25625007
OATP1B3; SLCO1B3; Colon cancer; Lung cancer; Cancer biomarker; Cancer-specific expression; Transporter
9.  Tumour-suppressive microRNA-29s inhibit cancer cell migration and invasion by targeting laminin–integrin signalling in head and neck squamous cell carcinoma 
British Journal of Cancer  2013;109(10):2636-2645.
Our recent studies of microRNA (miRNA) expression signatures demonstrated that microRNA-29s (miR-29s; miR-29a/b/c) were significantly downregulated in head and neck squamous cell carcinoma (HNSCC) and were putative tumour-suppressive miRNAs in human cancers. Our aim in this study was to investigate the functional significance of miR-29s in cancer cells and to identify novel miR-29s-mediated cancer pathways and responsible genes in HNSCC oncogenesis and metastasis.
Gain-of-function studies using mature miR-29s were performed to investigate cell proliferation, migration and invasion in two HNSCC cell lines (SAS and FaDu). To identify miR-29s-mediated molecular pathways and targets, we utilised gene expression analysis and in silico database analysis. Loss-of-function assays were performed to investigate the functional significance of miR-29s target genes.
Restoration of miR-29s in SAS and FaDu cell lines revealed significant inhibition of cancer cell migration and invasion. Gene expression data and in silico analysis demonstrated that miR-29s modulated the focal adhesion pathway. Moreover, laminin γ2 (LAMC2) and α6 integrin (ITGA6) genes were candidate targets of the regulation of miR-29s. Luciferase reporter assays showed that miR-29s directly regulated LAMC2 and ITGA6. Silencing of LAMC2 and ITGA6 genes significantly inhibited cell migration and invasion in cancer cells.
Downregulation of miR-29s was a frequent event in HNSCC. The miR-29s acted as tumour suppressors and directly targeted laminin–integrin signalling. Recognition of tumour-suppressive miRNA-mediated cancer pathways provides new insights into the potential mechanisms of HNSCC oncogenesis and metastasis and suggests novel therapeutic strategies for the disease.
PMCID: PMC3833206  PMID: 24091622
miR-29s; tumour suppressor; LAMC2; ITGA6; metastasis; HNSCC
10.  Effects of ionizing radiation on retinoic acid-inducible gene-I-like receptors 
Biomedical Reports  2014;3(1):59-62.
Retinoic acid-inducible gene-I (RIG-I)-like receptors [RLRs; RIG-I and melanoma differentiation-associated gene 5 (MDA5)] sense virus-derived RNA or a synthetic analog of double-stranded RNA polyinosinic-polycytidylic acid [poly(I:C)] and are responsible for host defense against viruses. However, it remains unclear whether radiation affects RLRs. Therefore, the present study investigated the effects of ionizing radiation on RIG-I and MDA5 expression and the response to poly(I:C) using THP1 (human monocytic cell line)-derived macrophages. Non- and X-irradiated (1–10 Gy) macrophages expressed RIG-I and MDA5 at mRNA and protein levels and there was no significant difference in the expression levels. Non- and X-irradiated macrophages expressed antiviral cytokine interferon (IFN)-β mRNA following poly(I:C)-low molecular weight/LyoVec™ and poly(I:C)-high molecular weight/LyoVec™ stimulation, the agonist of RIG-I and MDA5, respectively. In line with the results of the expression of RIG-I and MDA5, no significant difference in the expression of IFN-β mRNA was observed between non- and X-irradiation. These results indicate that ionizing radiation hardly affects RLR expression and the response to their agonist poly(I:C) in THP1-derived macrophages.
PMCID: PMC4251266  PMID: 25469248
retinoic acid-inducible gene-I; ionizing radiation; polyinosinic-polycytidylic acid; melanoma differentiation-associated gene 5; interferon-β
11.  Lymphoepithelioma-like carcinoma of the urinary bladder: a case report and review of the literature 
BMC Research Notes  2014;7(1):779.
Lymphoepithelioma-like carcinoma is an undifferentiated carcinoma with histological features similar to undifferentiated, non-keratinizing carcinoma of the nasopharynx. Lymphoepithelioma-like carcinoma of the urinary bladder is uncommon with a reported incidence of 0.3%– 1.3% of all bladder cancer. We report a Japanese case of predominant lymphoepithelioma-like carcinoma of the urinary bladder and review all of the English literature after performing a pooled analysis of the cases including the present one.
Case presentation
An 83-year-old Japanese man was introduced to our department with the chief complaint of macroscopic hematuria. Cystoscopy demonstrated a thumb tip-sized bladder tumor at the trigone. The patient underwent a transurethral resection of the bladder tumor. The pathological examination showed predominant lymphoepithelioma-like carcinoma of the urinary bladder with urothelial carcinoma. The patient was diagnosed with muscle invasive lymphoepithelioma-like carcinoma of the urinary bladder and was treated with concurrent chemoradiotherapy. The patient is under observation with regular clinical follow-up and remains well after 12 months, with no evidence of disease recurrence. The reports of 93 patients including the present one of lymphoepithelioma-like carcinoma of the urinary bladder from the English literature were collected between 1991 and 2014. Patients were evaluated for clinicopathological findings. Outcome resulted as follows: 59 patients (67%) did not show evidence of disease, 14 (17%) died of disease, 5 (6%) was alive with metastases, and 9 (10%) died for causes unrelated to the primary disease. Cause-specific survival rate resulted 83%. The overall patients were divided into three groups (pure, predominant and focal) according to the lymphoepithelioma-like carcinoma of the urinary bladder classification of Amin et al.
Because lymphoepithelioma-like carcinoma of the urinary bladder is more sensitive to both chemotherapy and radiotherapy than conventional urothelial carcinoma, radical cystectomy may not be necessary for all patients with muscle invasive lymphoepithelioma-like carcinoma of the urinary bladder. Therefore, pathological information may be useful in selecting patients suitable for bladder-preservation treatment. On the other hand, the apparently more aggressive nature of focal lymphoepithelioma-like carcinoma of the urinary bladder suggests that these patients are probably best managed with radical cystectomy and adjuvant treatment.
PMCID: PMC4233068  PMID: 25367311
Lymphoepithelioma-like carcinoma; Urinary bladder; Bladder-preservation treatment
12.  Increase of TRPV1-Immunoreactivity in Dorsal Root Ganglia Neurons Innervating the Femur in a Rat Model of Osteoporosis 
Yonsei Medical Journal  2014;55(6):1600-1605.
Transient receptor potential vanilloid 1 (TRPV1) is a ligand-gated nonselective cation channel, which can be activated by capsaicin and other noxious stimuli. Recently, an association between bone pain and TRPV1 has been reported. However, the influence of osteoporosis on TRPV1 in the sensory system innervating the femur has not been reported.
Materials and Methods
TRPV1-immunoreactive (ir) in dorsal root ganglia (DRG) neurons labeled with neurotracer [Fluoro-Gold (FG)] innervating the femurs of Sprague Dawley rats were examined in control, sham, and ovariectomized (OVX) rats. We evaluated osteoporosis in the femurs and compared the proportion of TRPV1-ir DRG neurons innervating femur between the 3 groups of rats.
OVX rats showed osteoporotic cancellous bone in the femur. FG labeled neurons were distributed from L1 to L6 DRG, but there was no significant difference in the proportion of labeled neurons between the 3 groups (p>0.05). The proportions of FG labeled TRPV1-ir DRG neurons were 1.7%, 1.7%, and 2.8% of DRG neurons innervating the femur, in control, sham-operated, and OVX rats, respectively. The proportion of TRPV1-ir neurons in DRG innervating the femur in OVX rats was significantly higher than that in control and sham-operated rats (p<0.05).
Under physiological conditions, DRG neurons innervating femurs in rats contain TRPV1. Osteoporosis increases the numbers of TRPV1-ir neurons in DRG innervating osteoporotic femurs in rats. These findings suggest that TRPV1 may have a role in sensory perception of osteoporotic femurs.
PMCID: PMC4205700  PMID: 25323897
Osteoporosis; pain; transient receptor potential vanilloid 1; femur
13.  Kaempferia parviflora extract increases energy consumption through activation of BAT in mice 
Food Science & Nutrition  2014;2(6):634-637.
Kaempferia parviflora (KP) is a member of the ginger family and is known in Thailand as Thai ginseng, Krachai Dam or Black Ginger. TheK. parviflora extract (KPE) was previously reported to have a number of physiological effects; however, the antiobesity effects of KPE and its mechanisms remain to be elucidated. In this study, we conducted KPE feeding experiments (low dose: 0.5% KPE, high dose: 1.0% KPE) in mice to examine the antiobesity effects. For both 0.5% KPE and 1.0% KPE, 7 weeks’ feeding of KPE contained in a high-fat diet (HFD) significantly decreased body weight gain, intraabdominal fat accumulation, and plasma triglyceride and leptin levels. Concurrently, KPE administration increased oxygen consumption in mice fed on a HFD. We also found that 1.0% KPE feeding significantly increased the uncoupling protein 1 (UCP1) expression in brown adipose tissue (BAT). Moreover, KPE administration increased urinary noradrenaline secretion levels. These results demonstrate that KPE promotes energy metabolism by activation of BAT, at both doses and up-regulation of UCP1 protein at a high dose. Although numerous challenges remain, the present study demonstrated that KPE suppresses HFD-induced obesity through increased energy metabolism.
PMCID: PMC4256566  PMID: 25493179
cAMP; Kaempferia parviflora; oxygen consumption; UCP1
14.  Hyaluronic Acid Concentration in Pleural Fluid: Diagnostic Aid for Tuberculous Pleurisy 
A high concentration of hyaluronic acid in pleural fluid is suggestive of malignant mesothelioma. However, a relatively high concentration of hyaluronic acid was also seen in the pleural fluid of patients with benign inflammatory diseases. To show the utility of measuring hyaluronic acid levels in pleural fluid to diagnose tuberculous pleurisy, we compared the clinical features and levels of hyaluronic acid in the pleural fluid of patients with and without tuberculous pleurisy.
We enrolled 27 patients with infective pleurisy admitted at Teikyo University Hospital from January 2010 to December 2013. Ten patients were diagnosed with tuberculous pleurisy, and 17 with non-tuberculous pleurisy. We reviewed the clinical features and data of all 27 patients and compared the two groups. We analyzed and compared the concentration of hyaluronic acid and adenosine deaminase in their pleural fluid.
Patients with tuberculous pleurisy tended to have significantly higher concentrations of hyaluronic acid and adenosine deaminase in their pleural fluid (tuberculous pleurisy patients vs. other infective pleurisy patients: hyaluronic acid (× 103 ng/mL); 42.9 ± 23.3 vs. 16.8 ± 17.9, P = 0.003, adenosine deaminase (IU/L); 89.7 ± 33.3 vs. 74.0 ± 90.9, P = 0.032). Receiver operating characteristic analysis revealed no significant difference in the area under the curve of hyaluronic acid and adenosine deaminase volumes in pleural fluid, suggesting their equivalent value as major diagnostic tools for tuberculosis pleurisy.
Hyaluronic acid concentration in pleural fluid can be a valuable tool for the diagnosis of tuberculous pleurisy.
PMCID: PMC4217753  PMID: 25368701
Hyaluronic acid; Adenosine deaminase; Tuberculosis pleurisy; Diagnostic aid
15.  Levetiracetam improves disinhibitory behavior in nonconvulsive status epilepticus 
Nonconvulsive status epilepticus (NCSE) is a severe medical condition and heterogeneous disorder defined by different seizure types and diverse etiologies. NCSE occurs commonly in the elderly and is potentially misdiagnosed as a psychiatric disorder. Current treatment options for NCSE are still unsatisfactory.
Case presentation
We report a case of NCSE in a 55-year-old epileptic male patient with a history of infectious encephalitis, disinhibitory behavior, and a suspected diagnosis of frontotemporal dementia. Add-on levetiracetam (LEV) to carbamazepine treatment improved clinical manifestations and abnormal electroencephalographic discharge.
With disinhibitory behavior in the elderly, the possibility of NCSE should be considered. Moreover, LEV may be an effective and well-tolerated pharmacotherapy for elderly NCSE patients.
PMCID: PMC4205286  PMID: 25339976
Disinhibitory behavior; Levetiracetam; Nonconvulsive status epilepticus; Psychiatric disorder; Infectious encephalitis
16.  Identification and adjustment of experimental occlusal interference using functional magnetic resonance imaging 
BMC Oral Health  2014;14(1):124.
The purpose of this study was to use functional magnetic resonance imaging (fMRI) to quantify changes in brain activity during experimental occlusal interference.
Fourteen healthy volunteers performed a rhythmical tapping occlusion task with experimental occlusal interference of the right molar tooth at 0 mm (no occlusion), 0.5 mm, and 0.75 mm. The blood-oxygen-level dependent (BOLD) signal was quantified using statistical parametric mapping and compared between rest periods and task periods.
In tapping tasks with experimental occlusal interference of 0.75 mm or 0.5 mm, there was clear activation of the contralateral teeth-related primary sensory cortex and Brodmann’s area 46. At 0 and 30 minutes after removal of the experimental occlusal interference, the activation clearly appeared in the bilateral teeth-related primary sensory cortices and Brodmann’s area 46. At 60 minutes after the removal of the experimental occlusal interference, the activation of Brodmann’s area 46 had disappeared, and only the bilateral teeth-related primary sensory cortices were active.
The present results suggest that adjustments for experimental occlusal interference can be objectively evaluated using fMRI. We expect that this method of evaluating adjustments in occlusal interference, combined with fMRI and the tapping task, could be applied clinically in the future.
PMCID: PMC4200220  PMID: 25304016
fMRI; Occlusion; Interference; Tooth; Brain; Function; Adjustments
17.  Clear cell adenocarcinoma of the peritoneum: a case report and literature review 
Clear cell adenocarcinoma (CCC) is generally thought to originate from ovarian, endometrial, or renal tissue. A CCC of the peritoneum (CCAP) is an extremely rare medical condition and is associated with a poor prognosis. To date, only 10 cases of CCAP have been reported, of which half resulted in death or recurrence within 6 months after initial treatment because CCAP is commonly resistant to multiple drugs. In this report, we present a case of CCAP of the pouch of Douglas coexisting with an endometriosis and we offer a review of the related literature.
PMCID: PMC4219116  PMID: 25366349
Clear cell adenocarcinoma; Peritoneum; Endometriosis; Ovarian cancer
18.  Estrogen Receptor Expression and Increased Risk of Lymphovascular Space Invasion in High-grade Serous Ovarian Carcinoma 
Gynecologic oncology  2014;133(3):473-479.
Recent studies have demonstrated that lymphovascular space invasion (LVSI) is associated with increased risk of hematogenous and lymphatic metastasis and poor clinical outcome of women with epithelial ovarian cancer. Given the suspected role of estrogen in promoting ovarian cancer metastasis, we examined potential links between estrogen receptor and LVSI in high-grade serous ovarian carcinoma.
Tumoral expression of ER, PR, p53, MDR1, EGFR, HER2, DNA ploidy, and S-phase fraction was examined for 121 cases of stage I-IV high-grade serous ovarian carcinoma samples obtained at primary cytoreductive surgery. Biomarker expression was correlated to LVSI and survival outcomes.
LVSI was observed in 101 (83.5%) of all cases. Immunohistochemistry of tested biomarkers showed ER (86.7%) to be the most commonly expressed followed by p53 (71.4%), HER2 (68.3%), EGFR (52.1%), MDR-1 (14.3%), and PR (8.9%). ER expression was positively correlated to PR expression (r=0.31, p=0.001). LVSI was only correlated with ER (odds ratio 6.27, 95%CI 1.93-20.4, p=0.002) but not with other biomarkers. In multivariate analysis, ER remained significantly associated with LVSI (p=0.039). LVSI remained a significant prognostic factor for decreased progression-free survival (HR 3.01, 95%CI 1.54-5.88, p=0.001) and overall survival (HR 2.69, 95%CI 1.18-6.23, p=0.021) while ER-expression did not remain as a significant variable in multivariate analysis.
Our data demonstrated that estrogen receptor was positively correlated with LVSI that was an independent prognostic indicator of poor survival outcomes of high-grade serous ovarian carcinoma. This study emphasizes the importance of estrogen pathway in promoting lymphatic or vascular spread of high-grade serous ovarian carcinoma.
PMCID: PMC4170217  PMID: 24674832
ovarian cancer; high-grade serous ovarian carcinoma; lymphovascular space invasion; estrogen receptor
19.  Tracking Difference in Gene Expression in a Time-Course Experiment Using Gene Set Enrichment Analysis 
PLoS ONE  2014;9(9):e107629.
Fistulifera sp. strain JPCC DA0580 is a newly sequenced pennate diatom that is capable of simultaneously growing and accumulating lipids. This is a unique trait, not found in other related microalgae so far. It is able to accumulate between 40 to 60% of its cell weight in lipids, making it a strong candidate for the production of biofuel. To investigate this characteristic, we used RNA-Seq data gathered at four different times while Fistulifera sp. strain JPCC DA0580 was grown in oil accumulating and non-oil accumulating conditions. We then adapted gene set enrichment analysis (GSEA) to investigate the relationship between the difference in gene expression of 7,822 genes and metabolic functions in our data. We utilized information in the KEGG pathway database to create the gene sets and changed GSEA to use re-sampling so that data from the different time points could be included in the analysis. Our GSEA method identified photosynthesis, lipid synthesis and amino acid synthesis related pathways as processes that play a significant role in oil production and growth in Fistulifera sp. strain JPCC DA0580. In addition to GSEA, we visualized the results by creating a network of compounds and reactions, and plotted the expression data on top of the network. This made existing graph algorithms available to us which we then used to calculate a path that metabolizes glucose into triacylglycerol (TAG) in the smallest number of steps. By visualizing the data this way, we observed a separate up-regulation of genes at different times instead of a concerted response. We also identified two metabolic paths that used less reactions than the one shown in KEGG and showed that the reactions were up-regulated during the experiment. The combination of analysis and visualization methods successfully analyzed time-course data, identified important metabolic pathways and provided new hypotheses for further research.
PMCID: PMC4182424  PMID: 25268590
20.  Randomized controlled phase III trial of adjuvant chemo-immunotherapy with activated killer T cells and dendritic cells in patients with resected primary lung cancer 
We conducted a phase III randomized controlled trial (RCT) to investigate the efficacy of postsurgical adjuvant immunotherapy combined with chemotherapy. The immunotherapy targets were residual micrometastases and clones resistant to chemotherapy.
Patients and methods
Between April 2007 and July 2012, 103 postsurgical non-small cell lung cancer patients were randomly assigned to receive either chemo-immunotherapy (group A) or chemotherapy (group B). The immunotherapy consisted of the adoptive transfer of autologous activated killer T cells and dendritic cells obtained from the lung cancer patients’ own regional lymph nodes.
The 2-year overall survival rates in groups A and B were 93.4 and 66.0 %, and the 5-year rates were 81.4 and 48.3 %, respectively. The differences were statistically significantly better in group A. The hazard ratio (HR) was 0.229 (p = 0.0013). The 2- and 5-year recurrence-free survival rates were 68.5, 41.4 and 56.8, 26.2 % in groups A and B, respectively. Those differences were also statistically significant (log-rank test p = 0.0020). The HR was 0.423 (p = 0.0027) in favor of group A. As for adverse reactions to immunotherapy, of a total of 762 courses, 52 (6.8 %) were accompanied with chills and shivering, and 47 (6.2 %), with fever (>38 °C).
Immunotherapy has the potential to improve the postsurgical prognosis of lung cancer patients, but a large-scale multi-institutional RCT is awaited for further confirmation of this study.
Electronic supplementary material
The online version of this article (doi:10.1007/s00262-014-1613-0) contains supplementary material, which is available to authorized users.
PMCID: PMC4282697  PMID: 25262164
Phase III study; Lung cancer; Adjuvant therapy; Immunotherapy; Lymph node; Dendritic cell
21.  Efficacy of ribavirin against malignant glioma cell lines 
Oncology Letters  2014;8(6):2469-2474.
Ribavirin (1-β-D-ribofuranosy-1,2,4-triazole-3-carboxamide) has been widely administered as an antiviral agent against RNA and DNA viruses. Ribavirin, in combination with interferon, has predominantly been applied in the treatment of the hepatitis C virus infection and its potential antitumor efficacy has recently become a point of interest. The aim of the present study was to evaluate the effect of ribavirin on the growth of malignant glioma cells, to identify novel predictive genes in malignant glioma cells (by analyzing gene expression profiles) and to assess the influence of ribavirin on the cell cycle of malignant glioma cells. The present study evaluated the antitumor efficacy of ribavirin against various malignant glioma cell lines (A-172, AM-38, T98G, U-87MG, U-138MG, U-251MG and YH-13). After culturing the cells in ribavirin-containing culture medium (final concentration, 0–1,000 μM) for 72 h, the viable proliferated cells were harvested and counted. The half maximal inhibitory concentration of ribavirin, with regard to the growth of the malignant glioma cell lines, was determined from the concentration of ribavirin required for 50% growth inhibition in comparison to the untreated control cells. Furthermore, the current study identified the genes in which the gene expression levels correlated with the ribavirin sensitivity of the malignant glioma cells lines, using a high-density oligonucleotide array. Finally, cell cycle analysis was performed on the U-87MG cell line. It was identified that ribavirin inhibited the growth of all of the malignant glioma cell lines in a dose-dependent manner, although the ribavirin sensitivity varied between each cell line. Of the extracted genes, PDGFRA demonstrated the strongest positive correlation between gene expression level and ribavirin sensitivity. Cell cycle analysis of the U-87MG cell line demonstrated that ribavirin treatment induces G0/G1 arrest and thus may be an effective agent for inhibiting malignant glioma cell growth. Therefore, the results of the current study indicate that ribavirin may have potential as a therapeutic agent in the treatment of malignant gliomas.
PMCID: PMC4214453  PMID: 25364409
ribavirin; malignant glioma
22.  Effect of Lymphovascular Space Invasion on Survival of Stage I Epithelial Ovarian Cancer 
Obstetrics and gynecology  2014;123(5):957-965.
To evaluate the effect of lymphovascular space invasion on survival of early-stage epithelial ovarian cancer patients.
A multicenter retrospective study was conducted for patients with stage IA-C epithelial ovarian cancer who underwent primary comprehensive surgery including lymphadenectomy. Histopathology slides for ovarian tumors were examined by gynecologic pathologists for presence or absence of lymphovascular space invasion. Survival analysis was performed examining tumoral factors.
A total of 434 cases were included in the analysis. Lymphovascular space invasion was detected in 76 (17.5%) cases, associated with histology (p=0.042) and stage (p=0.044). Lymphovascular space invasion was significantly associated with decreased survival outcomes (disease-free survival [DFS], 5-year rate 78.4% versus 90.7%, p=0.024, and overall survival [OS], 84.9% versus 93.2%, p=0.031) in univariate analysis. In multivariate analysis, lymphovascular space invasion did not remain a significant variable for DFS (hazard ratio [HR] 1.98, 95%CI 0.97-3.97, p=0.059) or OS (HR 2.41, 95%CI 0.99-5.85, p=0.052). Lymphovascular space invasion was associated with increased risk of hematogenous and lymphatic metastasis (HR 4.79, 95%CI 1.75-13.2, p=0.002) but not peritoneal metastasis (p=0.33) in multivariate analysis. Among lymphovascular space invasion-expressing tumors, patients who received fewer than 6 cycles of postoperative chemotherapy had significantly poorer DFS than those who received six or more cycles (HR 4.59, 95%CI 1.20-17.5, p=0.015).
Lymphovascular space invasion is an important histological feature to identify a subgroup of patients with increased risk of recurrence in stage I epithelial ovarian cancer.
PMCID: PMC4174541  PMID: 24785846
23.  An Evolutionary-Conserved Function of Mammalian Notch Family Members as Cell Adhesion Molecules 
PLoS ONE  2014;9(9):e108535.
Notch family members were first identified as cell adhesion molecules by cell aggregation assays in Drosophila studies. However, they are generally recognized as signaling molecules, and it was unclear if their adhesion function was restricted to Drosophila. We previously demonstrated that a mouse Notch ligand, Delta-like 1 (Dll1) functioned as a cell adhesion molecule. We here investigated whether this adhesion function was conserved in the diversified mammalian Notch ligands consisted of two families, Delta-like (Dll1, Dll3 and Dll4) and Jagged (Jag1 and Jag2). The forced expression of mouse Dll1, Dll4, Jag1, and Jag2, but not Dll3, on stromal cells induced the rapid and enhanced adhesion of cultured mast cells (MCs). This was attributed to the binding of Notch1 and Notch2 on MCs to each Notch ligand on the stromal cells themselves, and not the activation of Notch signaling. Notch receptor-ligand binding strongly supported the tethering of MCs to stromal cells, the first step of cell adhesion. However, the Jag2-mediated adhesion of MCs was weaker and unlike other ligands appeared to require additional factor(s) in addition to the receptor-ligand binding. Taken together, these results demonstrated that the function of cell adhesion was conserved in mammalian as well as Drosophila Notch family members. Since Notch receptor-ligand interaction plays important roles in a broad spectrum of biological processes ranging from embryogenesis to disorders, our finding will provide a new perspective on these issues from the aspect of cell adhesion.
PMCID: PMC4177923  PMID: 25255288
24.  Placenta percreta managed by transverse uterine fundal incision with retrograde cesarean hysterectomy: a novel surgical approach 
Clinical Case Reports  2014;2(6):260-264.
Key Clinical Message
Placenta percreta (with bladder invasion) is a rare obstetric condition with the risk of massive intraoperative hemorrhage. In these cases, the combination of a transverse uterine fundal incision and retrograde cesarean hysterectomy could be useful to minimize maternal hemorrhage and avoid severe bladder injury.
PMCID: PMC4270707  PMID: 25548627
Hemorrhage; placenta percreta; retrograde hysterectomy; transverse uterine fundal incision
25.  Annexin A4 induces platinum resistance in a chloride-and calcium-dependent manner 
Oncotarget  2014;5(17):7776-7787.
Platinum resistance has long been a major issue in the treatment of various cancers. We previously reported that enhanced annexin A4 (ANXA4) expression, a Ca2+-regulated phospholipid-binding protein, induces chemoresistance to platinum-based drugs. In this study, we investigated the role of annexin repeats, a conserved structure of all the annexin family, responsible for platinum-resistance as well as the effect of knockdown of ANXA4. ANXA4 knockdown increased sensitivity to platinum-based drugs both in vitro and in vivo. To identify the domain responsible for chemoresistance, ANXA4 deletion mutants were constructed by deleting annexin repeats one by one from the C terminus. Platinum resistance was induced both in vitro and in vivo in cells expressing either full-length ANXA4 or the deletion mutants, containing at least one intact annexin repeat. However, cells expressing the mutant without any calcium-binding sites in the annexin repeated sequence, which is essential for ANXA4 translocation from the cytosol to plasma membrane, failed to acquire platinum resistance. After cisplatin treatment, the intracellular chloride ion concentration, whose channel is partly regulated by ANXA4, significantly increased in the platinum-resistant cells. These findings indicate that the calcium-binding site in the annexin repeat induces chemoresistance to the platinum-based drug by elevating the intracellular chloride concentration.
PMCID: PMC4202160  PMID: 25277200
Annexin A4; platinum resistance; annexin repeat; chloride ion

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