Transient EDTA-dependent pseudothrombocytopenia and ulcerative colitis recurrence during chemotherapy: A case of misleading platelet count results attributable to a laboratory artifact.

Key Clinical Message: EDTA-dependent pseudothrombocytopenia as well as myelosuppression should be suspected when thrombocytopenia occurs in patients with autoimmune disease during chemotherapy. Abstract: A patient with pancreatic cancer and ulcerative colitis developed transient ethylenediaminetetraacetic acid (EDTA)-dependent pseudothrombocytopenia with exacerbation of ulcerative colitis during chemotherapy. Unfortunately, pseudothrombocytopenia could not be immediately detected because thrombocytopenia was masked by a reasonable time course of adverse events associated with chemotherapy and ulcerative colitis recurrence. When thrombocytopenia occurs during chemotherapy, especially in patients with autoimmune diseases, EDTA-dependent pseudothrombocytopenia and bone marrow suppression caused by anti-cancer agents should be suspected.

Dexamethasone to prednisolone rotation relieved hiccups in colorectal cancer patient continuing teleworking during anticancer therapy.

We present a case of chemotherapy-induced hiccups that were alleviated by steroid rotation. Hiccups are often overlooked, but they have an impact on the patient's quality of life. In the COVID-19 era, web-based teleworking has become an important tool, hiccups during a teleconference should be noted as a concern for patients.

Single-Drug Approach with Edoxaban is Effective for Resolving Non-Acute Cancer-Associated Venous Thrombosis: A Single-Arm Retrospective Analysis.

Recently, cancer-related venous thromboembolism (VTE) has been termed "cancer-associated thrombosis (CAT)" and is the focus of current research. We retrospectively investigated the efficacy of a single-drug approach with edoxaban for the treatment of non-acute CAT. Thirty-two non-acute CAT patients who received edoxaban were analyzed. The primary endpoint of this analysis was the thrombus disappearance rate at the first evaluation. Secondary endpoints included progression/recurrence of VTE, major bleeding, and D-dimer levels. The thrombus disappearance rate was 62.5%. Therefore, the null hypothesis for the primary endpoint (thrombus disappearance rate of ≤32.0%) was rejected (p = 0.00038) based on the rate of the previous study as the historical control. Recurrent VTE and major bleeding occurred in two patients each. After the start of treatment with edoxaban, a significant difference in D-dimer levels was observed (p = 0.00655). We demonstrated that a single-drug approach with edoxaban is a potential treatment option for non-acute CAT.

Variants of carboxylesterase 1 have no impact on capecitabine pharmacokinetics and toxicity in capecitabine plus oxaliplatin treated-colorectal cancer patients.

PURPOSE: Capecitabine is a prodrug that undergoes metabolism in three steps to form an active 5-fluorouracil (5-FU). The first step is primarily catalyzed by liver carboxylesterases (CES) 1. Here, we examined the effects of CES1 variants on pharmacokinetics and toxicity of capecitabine. METHODS: We enrolled postoperative colorectal cancer (CRC) patients administered with adjuvant capecitabine plus oxaliplatin (CapeOX) and metastatic CRC patients receiving CapeOX. The pharmacokinetic analysis of the first capecitabine dose (1000 mg/m2) was done on day 1, and oxaliplatin administration was shifted to day 2. Plasma concentrations of capecitabine, 5'-deoxy-5-fluorocytidine, 5'-deoxy-5-fluorouridine (5'-DFUR), and 5-FU were analyzed by high-performance liquid chromatography. CES1 polymorphisms (rs3217164, rs2244614, rs2244613, rs7187684, and rs11861118) and the functional CES1 genes (1A1, var1A1, 1A2, and pseudo 1A3) in their diplotype configurations were analyzed by direct sequencing. RESULTS: Thirty-seven patients were enrolled from September 2017 to February 2020. Patients with a higher area under the plasma concentration-time curve to capecitabine dose ratio (AUC/dose) of 5'-DFUR than its mean showed a higher frequency of overall ≥ grade 3 toxicity and lower relative dose intensity (RDI) of capecitabine than those with a lower ratio. Higher CES1 activity expressed as a metabolic ratio (AUC of capecitabine/sum of three AUCs of each metabolite) lower than its mean was associated with higher 5'-DFUR AUC/dose and lower RDI, indicating essential roles of CES1 in capecitabine activation to produce 5'-DFUR. However, the association between CES1 variants and capecitabine pharmacokinetics and toxicity was not significant. CONCLUSION: CES1 variants are not associated with capecitabine pharmacokinetics and toxicity.

VEGF Inhibitors Do Not Increase D-dimer Levels in Colorectal Cancer Patients Without Venous Thromboembolism: A Retrospective Non-inferiority Analysis

BACKGROUND/AIM: If VEGF inhibitors contribute to an increase in D-dimer levels, they may adversely affect the diagnosis of venous thromboembolism (VTE). Consequently, this retrospective study examined the effects of VEGF inhibitors on D-dimer levels in colorectal cancer patients. PATIENTS AND METHODS: A total of 104 colorectal cancer patients who received chemotherapy, were included in this study. To perform D-dimer analysis, patients were divided into two analysis targets: patients with VTE and without VTE. Statistical analysis included a natural logarithmic transformation of D-dimer data. RESULTS: In the D-dimer analysis of non-VTE patients, the natural logarithm D-dimer mean difference was -0.186, with a 95% CI of -0.525 to 0.154. The upper limit of the 95%CI (0.154) did not exceed the non-inferiority margin (Δ) of 0.199, and therefore met the non-inferiority criteria. CONCLUSION: VEGF inhibitors don't contribute to increased D-dimer levels in colorectal cancer patients without VTE.

Two cases of lymphangitic carcinomatosis as the primary symptom of colorectal carcinoma that achieved complete remission using combination anti-EGFR antibody therapy.

Clinicians often encounter cases of pulmonary lymphangitic carcinomatosis when treating patients with cancer. When such a condition develops before the diagnosis of cancer, its diagnosis is often challenging. Herein, we report about two patients with colorectal carcinoma diagnosed after the identification of lymphangitic carcinomatosis, which achieved complete remission with combination anti-epidermal growth factor receptor (anti-EGFR) antibody therapy. In case 1, a 74-year-old woman presented with cough and dyspnea that had persisted for 1 month. She had unresectable advanced carcinoma of the sigmoid colon with lymphangitic carcinomatosis. Her respiratory status gradually deteriorated due to the disease. Thus, FOLFIRI plus cetuximab therapy was initiated. Her dyspnea rapidly resolved with the treatment, and complete remission of lymphangitic carcinomatosis was achieved. In case 2, a 46-year-old man presented with fever and dyspnea that had persisted for 1 month. He had unresectable advanced carcinoma of the transverse colon with lymphangitic carcinomatosis. FOLFOXIRI therapy was then initiated. However, his respiratory status did not improve. Therefore, his treatment was immediately switched to FOLFIRI plus panitumumab. His dyspnea rapidly resolved with the treatment, and complete remission of lymphangitic carcinomatosis was achieved. In oncologic emergencies, such as lymphangitic carcinomatosis, requiring an early response to treatment, the administration of anti-EGFR antibodies may be a highly effective treatment option.

Inhibition of enamel demineralization by an ion-releasing tooth-coating material.

PURPOSE: To evaluate the inhibitory effect of a surface pre-reacted glass-ionomer (S-PRG) filler-containing tooth-coating material on enamel demineralization. The outer surface of the S-PRG filler is in a state in which ions are readily released. METHODS: Human enamel blocks were incubated in lactic acid solution (pH 4.0) with and without a disk (n=6) made of the cured tooth-coating material. Test solutions were changed every 24 hours and incubation was continued for 4 days. The pH and amount of fluoride released were measured with an electrode and ion meter, respectively. The concentrations of ions (aluminum, boron, calcium, phosphorus, silicon, sodium, and strontium) were measured by inductively coupled plasma atomic emission spectroscopy. The surface of the enamel block was observed with a scanning electron microscope. RESULTS: Enamel demineralization was not observed in an enamel block incubated with a disk of the tooth-coating material. Ions released from S-PRG filler had an acid buffering action in the low pH lactic acid solution. However, in the enamel block-only solution showing high levels of calcium ion release, the degree of demineralization was correlated with morphological changes of the enamel surface. CLINICAL SIGNIFICANCE: Due to the buffering effects of the pre-reacted glass-ionomer surface by ion release, the S-PRG filler-containing tooth-coating material inhibited enamel demineralization by neutralizing the acidic environment at an early time point.

Early tumor shrinkage as a predictor of favorable outcomes in patients with advanced pancreatic cancer treated with FOLFIRINOX.

There are several reports on the correlation between early tumor shrinkage (ETS) or depth of response (DpR) and survival in chemotherapies for colorectal cancer; however, few studies have investigated it in pancreatic cancer. We therefore investigated whether the ETS will predict outcomes in 59 patients with advanced pancreatic cancer treated with FOLFIRINOX therapy. The association of ETS with progression-free survival (PFS) and overall survival (OS) was evaluated but also we addressed to the correlation between outcomes and DpR. ETS was defined as a reduction ≥ 20% of target lesions' diameters measured at 6 to 8 weeks from treatment start. DpR was percentage of maximal tumor shrinkage observed at the nadir diameter compared with baseline. Among 47 evaluable patients for the ETS, 12 (25.5%) patients experienced ETS. The ETS was significantly associated with better PFS (9.0 vs. 4.2 months) as well as OS (24.0 vs. 9.1 months); moreover, the association had a statistically significance for PFS but a strong trend for OS in multivariate analysis. The DpR was statistically significantly but weakly associated with OS. In conclusion, this is the first report that the early response to chemotherapy may predict favorable outcomes in patients with advanced pancreatic cancer treated with FOLFIRINOX therapy.

[A Case of HER2-Positive Esophagogastric Junction Cancer with Perforation Curatively Resected after Neoadjuvant Chemotherapy plus Trastuzumab].

A 60-year-old man was diagnosed with adenocarcinoma of the esophagogastric junction with lymph node metastasis along the left gastric artery. The clinical stage was determined to be T4b, N1, M0, Stage IIIB, and a neoadjuvant chemotherapy (NAC)regimen of capecitabine/CDDP plus trastuzumab was selected for treatment. Before 3 courses of chemotherapy, the patient developed perforated gastric cancer. With conservative therapy, we were able to obtain closure of the perforation without affecting the curability of the cancer. We changed the chemotherapy regimen to S-1/CDDP plus trastuzumab, and the patient underwent curative resection.

Inhibition of enamel demineralization and bond-strength properties of bioactive glass containing 4-META/MMA-TBB-based resin adhesive.

We investigated the enamel demineralization-prevention ability and shear bond strength (SBS) properties of 4-methacryloxyethyl trimellitic anhydride/methyl methacrylate-tri-n-butyl borane (4-META/MMA-TBB)-based resin containing various amounts (0-50%) of bioactive glass (BG). Disk-shaped specimens were immersed in distilled water and ions released were analysed by inductively coupled plasma atomic-emission spectroscopy. Samples were also immersed in lactic acid solution (pH 4.6) to estimate acid-neutralizing ability. Brackets were bonded to human premolars with BG-containing resins and the bonded teeth were alternately immersed in demineralizing (pH 4.55) and remineralizing (pH 6.8) solutions for 14 d. The enamel hardness was determined by nanoindentation testing at twenty equidistant distances from the external surface. The SBS for each sample was examined. The amounts of ions released [calcium (Ca), sodium (Na), silicon (Si), and boron (B)] and the acid-neutralizing ability increased with increasing BG content. After alternating immersion, the specimens bonded with the BG-containing resin with high BG content were harder than those in the other groups in some locations 1-18.5 µm from the enamel surface. Bioactive glass-containing (10-40%) resin had bond strength equivalent to the control specimen. Thus, the SBS obtained for BG-containing resin (6.5-9.2 MPa) was clinically acceptable, suggesting that this material has the ability to prevent enamel demineralization.

Inhibition of enamel demineralization by buffering effect of S-PRG filler-containing dental sealant.

The buffering capacity and inhibitory effects on enamel demineralization of two commercially available dental sealants were evaluated in this study. The effects of filler particles were also examined. Disks of enamel and cured sealant materials of BeautiSealant (silica or S-PRG filler) or Teethmate F-1 were incubated in lactic acid solutions (pH 4.0) for 1-6 d. The pH changes and amounts of ions released in the solutions were assessed, and enamel surfaces were observed using a scanning electron microscope. The pH of the solution with BeautiSealant (S-PRG filler) was neutralized from pH 4.0 to pH 6.1 (after incubation for 1 d) and from pH 4.0 to pH 6.7 (after incubation for 6 d). In addition, no release of calcium ions was detected and the enamel surface was morphologically intact in scanning electron microscopy images. However, the pH of the solution with Teethmate F-1 remained below pH 4.0 during incubation from days 1 to 6. Calcium release was increased in solutions up to and after 6 d of incubation. Scanning electron microscopy images showed that the structures of hydroxyapatite rods were exposed at the specimen surfaces as a result of demineralization. Ions released from S-PRG filler-containing dental sealant rapidly buffered the lactic acid solution and inhibited enamel demineralization.

Responses of RAW264.7 macrophages to water-dispersible gold and silver nanoparticles stabilized by metal-carbon σ-bonds.

Nanometals are currently receiving considerable attention for industrial and biomedical applications, but their potentially hazardous and toxic effects have not been extensively studied. This study evaluated the biological responses of novel water-dispersible gold (Au-NPs) and silver nanoparticles (Ag-NPs) stabilized by Au-C or Ag-C σ-bonds in cultured macrophages (RAW264.7), via analysis of the cell viability, the integrity of the plasma membrane, and the inflammatory and morphological properties. The cultured RAW264.7 was exposed to metal-NPs at various concentrations. The Ag-NPs showed cytotoxicity at high NP concentrations, but the cytotoxic effects of the Au-NPs were smaller than those of the Ag-NPs. For the microscopic analysis, both types of particles were internalized into cells, the morphological changes in the cells which manifested as an expansion of the vesicles' volume, were smaller for the Au-NPs compared with the Ag-NPs. For the Ag-NPs, the endocytosis abilities of the macrophages might have induced harmful effects, because of the expansion of the cell vesicles. Although an inflammatory response was observed for both the Au- and Ag-NPs, the harmful effects of the Au-NPs were smaller than those of the Ag-NPs, with minor morphological changes observed even after internalization of the NPs into the cells.

Micromorphological cellular responses of MC3T3-E1 and RAW264.7 after exposure to water-dispersible silver nanoparticles stabilized by metal-carbon σ-bonds.

With the continuous progress in nanomaterial development for biomedicine, the potential cytotoxicity of nanoparticles is drawing more attention and concern for clinical applications. The purpose of this study was to evaluate biological responses of new water-dispersible silver nanoparticles (Ag-NPs) stabilized by Ag-C σ-bonds in cultured murine macrophages (RAW264.7) and osteoblast-like cells (MC3T3-E1) using cell viability and morphological analyses. For RAW264.7, Ag-NPs seemed to induce cytotoxicity that was dependent on the Ag-NP concentration. However, no cytotoxic effects were observed in the MC3T3-E1 cell line. In microscopic analysis, Ag-NPs were taken up by MC3T3-E1 cells with only minor cell morphological changes, in contrast to RAW264.7 cells, in which particles aggregated in the cytoplasm and vesicles. The ability of endocytosis of macrophages may induce harmful effects due to expansion of cell vesicles compared to osteoblast-like cells with their lower uptake of Ag-NPs.

[5-FU/l-LV therapy is useful for hemodialysis patients with advanced gastric cancer].

A 71-year-old man receiving maintenance dialysis because of diabetic nephropathy presented with hematemesis at another hospital in January 2008. A gastrointestinal endoscopy demonstrated a II a-like lesion in the angle of the stomach, and he was admitted to our hospital. A diagnosis of gastric adenocarcinoma (cT2N2M0, Stage IIIA) was made. An operation could not be performed because of the high risk, so combination chemotherapy with 5-FU and l-LV was initiated. After 3 courses of treatment, the size of the primary tumor was markedly reduced. After 6 courses, the primary lesion had changed to a scar, and an endoscopic biopsy revealed no cancer cells. His performance status did not deteriorate, and no serious adverse events occurred during the course of treatment. Chemotherapy was continued because the overall response was SD. 5-FU/l-LV therapy should be considered as a safe and useful treatment for a hemodialysis patient with advanced gastric cancer.