[A Case of MSI-High Sigmoid Colon Cancer in Which Long-Term Survival Was Achieved by Pembrolizumab for Recurrent Lesions Resistant to Conventional Chemotherapy].

The patient underwent sigmoidectomy with D3 lymph node dissection and partial bladder resection for sigmoid colon cancer(cT4bN1M0, cStage Ⅲa), after preoperative chemotherapy with mFOLFOX plus panitumumab, and FOLFOXIRI plus bevacizumab. Postoperative adjuvant chemotherapy was performed by 8 courses of CAPOX. He relapsed hilar lymph nodes and peritoneal dissemination after 13 months after surgery, he underwent resection of the recurrent lesions. Four months after, he developed recurrence in liver and peritoneum. Although he was treated with FOLFIRI plus ramucirumab or aflibercept, resulted in progression of disease, then he received trifluridine tipiracil hydrochloride plus bevacizumab. At this point, the Japanese health insulance had started to cover pembrolizumab, this therapy was started as the fourth chemotherapy after the diagnosis of high frequency microsatellite instability(MSI), and then tumor markers rapidly declined. He underwent 38 courses of pembrolizumab, the recurrent lesions both liver and peritoneum disappeared. He had stoma closure, peritoneal dissemination disappeared not only intraoperatively but also in histologically from the peritoneal scar. He has received pembrolizumab for 4 years without another recurrence. Here, we report a case of MSI-high sigmoid colon cancer in which long-term survival was achieved by pembrolizumab for recurrent lesions resistant to conventional chemotherapy.

[A Case of Perforation of the Duodenum during Chemotherapy with Ramucirumab plus Nab-Paclitaxel for Advanced Gastric Cancer].

A 70-year-old male patient was diagnosed with advanced gastric cancer with para-aortic lymph node metastasis. After diagnostic laparoscopy, the patient received 2 courses of neoadjuvant chemotherapy. Subsequently, distal gastrectomy, D2 plus para-aortic lymph node dissection, and Roux-en-Y reconstruction were performed. An enlarged lymph node(No. 16b2)was identified during surgery. The histopathological diagnosis revealed ypT4b, ypN3b, cM1(LYM; No. 16), Stage ⅣB. Chemotherapy with ramucirumab plus nab-paclitaxel was administered at 6 weeks postoperatively. However, after 2 courses of chemotherapy, the patient developed an abscess discharge from the wound, which was confirmed by an abdominal CT scan and diagnosed as an intra-abdominal abscess derived from duodenal perforation. The abscess was drained percutaneously. Subsequently, chemotherapy with nab-paclitaxel, nivolumab, and trifluridine/tipiracil hydrochloride was administered. After the appearance of brain metastases, the treatment was shifted to palliative care. The patient died 2 years and 7 months later from the primary disease.

Incidence of upper extremity deep vein thrombosis in the retrosternal reconstruction after esophagectomy.

BACKGROUND: Upper extremity deep vein thrombosis (UEDVT) is relatively rare but cannot be negligible because it can cause fatal complications. Although it is reported that the occurrence rate of UEDVT has increased due to central venous catheter (CVC), cancer, and surgical invasion, there is still limited information for esophagectomy. The aim of this study was to evaluate the clinical factors, including CVC placement and thromboprophylaxis approach, as well as retrosternal space's width as a predictive factor for UEDVT in patients receiving esophagectomy. METHODS: This study included 66 patients who underwent esophagectomy with retrosternal reconstruction using a gastric tube. All patients routinely underwent contrast-enhanced computed tomography (CT) on the 4th postoperative day. Low-molecular-weight-heparin (LMWH) was routinely administered by the 2nd postoperative day. To evaluate retrosternal space's width, (a) The distance from sternum to brachiocephalic artery and (b) the distance from sternum to vertebra were measured by preoperative CT, and the ratio of (a) to (b) was defined as the width of retrosternal space. RESULTS: Among all patients, 11 (16.7%) suffered from UEDVT, and none was preoperatively received CVC placement, while 7 were inserted in non-UEDVT cases. Retrosternal space's width in patients with UEDVT was significantly smaller than that in patients without UEDVT (0.17 vs. 0.26; P < 0.0001). A cutoff value of the width was 0.21, which has high sensitivity (87%) and specificity (82%) for UEDVT prediction, respectively. CONCLUSION: The existence of CVC may not affect the development of UEDVT, but preoperative evaluation of retrosternal ratio may predict the occurrence of UEDVT.

Highly stable, extremely high-temperature, nonvolatile memory based on resistance switching in polycrystalline Pt nanogaps.

Highly stable, nonvolatile, high-temperature memory based on resistance switching was realized using a polycrystalline platinum (Pt) nanogap. The operating temperature of the memory can be drastically increased by the presence of a sharp-edged Pt crystal facet in the nanogap. A short distance between the facet edges maintains the nanogap shape at high temperature, and the sharp shape of the nanogap densifies the electric field to maintain a stable current flow due to field migration. Even at 873 K, which is a significantly higher temperature than feasible for conventional semiconductor memory, the nonvolatility of the proposed memory allows stable ON and OFF currents, with fluctuations of less than or equal to 10%, to be maintained for longer than eight hours. An advantage of this nanogap scheme for high-temperature memory is its secure operation achieved through the assembly and disassembly of a Pt needle in a high electric field.

Involvement of insulin-degrading enzyme in insulin- and atrial natriuretic peptide-sensitive internalization of amyloid-ß peptide in mouse brain capillary endothelial cells.

Cerebral clearance of amyloid-ß peptide (Aß), which is implicated in Alzheimer's disease, involves elimination across the blood-brain barrier (BBB), and we previously showed that an insulin-sensitive process is involved in the case of Aß1-40. The purpose of this study was to clarify the molecular mechanism of the insulin-sensitive Aß1-40 elimination across mouse BBB. An in vivo cerebral microinjection study demonstrated that [125I]hAß1-40 elimination from mouse brain was inhibited by human natriuretic peptide (hANP), and [125I]hANP elimination was inhibited by hAß1-40, suggesting that hAß1-40 and hANP share a common elimination process. Internalization of [125I]hAß1-40 into cultured mouse brain capillary endothelial cells (TM-BBB4) was significantly inhibited by either insulin, hANP, other natriuretic peptides or insulin-degrading enzyme (IDE) inhibitors, but was not inhibited by phosphoramidon or thiorphan. Although we have reported the involvement of natriuretic peptide receptor C (Npr-C) in hANP internalization, cells stably expressing Npr-C internalized [125I]hANP but not [125I]hAß1-40, suggesting that there is no direct interaction between Npr-C and hAß1-40. IDE was detected in plasma membrane of TM-BBB4 cells, and internalization of [125I]hAß1-40 by TM-BBB4 cells was reduced by IDE-targeted siRNAs. We conclude that elimination of hAß1-40 from mouse brain across the BBB involves an insulin- and ANP-sensitive process, mediated by IDE expressed in brain capillary endothelial cells.

Correlation of induction of ATP binding cassette transporter A5 (ABCA5) and ABCB1 mRNAs with differentiation state of human colon tumor.

The ATP binding cassette transporter subtype A5 (ABCA5)-like transporters ABCA5, ABCA6, ABCA8, ABCA9 and ABCA10 form a unique gene cluster within the ABC transporter superfamily, though their function is still poorly understood. The purpose of this study is to examine whether ABCA5-like transporters may play a role in tumor development by measuring their mRNA levels in human tissues and tumors. Intense mRNA expression of human ABCA5-like transporters was detected in the brain. ABCA5 and ABCA8 mRNAs were detected in spleen, testis and ovary. ABCA5 mRNA was also detected in liver and pancreas. ABCA6 mRNA was detected in lung and liver, and ABCA8 was detected in lung. ABCA6, ABCA7 and ABCA8 mRNAs were not detected in any tumors, but weak mRNA expression of ABCA10 was detected in all tumors examined. ABCA5 mRNA was detected in poorly differentiated colon adenocarcinoma (GI-112) and undifferentiated ovarian carcinoma (GI-102), but not in normal colon. ABCB1 mRNA was also detected in GI-112, while ABCC1 and ABCA2 mRNAs were not. In contrast, ABCC1 and ABCA2 mRNAs, but not ABCA5 or ABCB1 mRNA, were detected in well differentiated colon adenocarcinoma (CX-1). Thus, induction of ABCA5, together with ABCB1, appears to be correlated with the differentiation state of human colon tumors, and may have a role in tumor development.

mRNA expression of the ATP-binding cassette transporter subfamily A (ABCA) in rat and human brain capillary endothelial cells.

The ATP-binding cassette transporter subfamily A (ABCA) consists of the transporters mediating cholesterol release and regulated by cholesterol. As about 25% of total body cholesterol exists in the brain, sterol homeostasis is an important issue as far as central nervous system function is concerned. The purpose of this study was to clarify the mRNA expression of ABCA subtypes at the blood-brain barrier (BBB) using cultured rat and human brain capillary endothelial cells, TR-BBB and hBME cells, respectively. mRNA expression of ABCA1, 2, 3, 4, 5, 6, 7 and 8/9 was detected in TR-BBB cells. In the brain capillary-rich fraction, mRNA expression of ABCA1, 2, 3, 4, 5, 7 and 8/9 was detected. ABCA2 and 5 mRNA were also detected in hBME cells. These results demonstrate, for the first time, that ABCA subtypes are expressed at the rat and/or human BBB. The expression of ABCA subtypes at the BBB is likely to contribute to sterol homeostasis in the central nervous system.