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Laser speckle flowmetry (LSF) is a noninvasive tool for cerebral blood flow (CBF) measurement via a cranial bone window. LSF is influenced by various factors including the extent of removal of bone and dura mater and tissue wetness in the bone window. In this study, we aimed to characterize the effect of these conditions on LSF signals and identify optimal measurement conditions for CBF LSF measurements in rats. Three bone windows were created over the Sprague-Dawley rat brains including (i) bone removal until the brain surface was visible through the thin skull, (ii) complete bone removal for dura mater exposure, and (iii) dura mater removal for cortical surface exposure. We investigated the difference in the LSF signals of these windows under dry and wet conditions. The differences between signals obtained using artificial cerebrospinal fluid (aCSF) and mineral oil for wet conditions were also examined. Furthermore, we investigated the stability of repeated CBF measurements in thinned skulls over 15 days and the effects of gentamicin ointment. No significant difference was observed in the LSF values of the three bone windows under dry and wet conditions. Moreover, mineral oil may provide better LSF signal stability. CBF LSF measurements with minimum signal fluctuation were possible for 15 days using the thinned skull window with gentamicin ointment. In conclusion, CBF LSF measurements are feasible in rats using thinned skulls or dura matter in dry or wet environments, preferably with mineral oils. Relatively repetitive CBF LSF measurements were possible for long duration using gentamicin ointment for daily wound closure., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2025 The Authors. Published by Elsevier B.V. All rights reserved.) more...

Plastics that can metabolize in oceans are highly sought for a sustainable future. In this work, we report the noncovalent synthesis of unprecedented plastics that are mechanically strong yet metabolizable under biologically relevant conditions owing to their dissociative nature with electrolytes. Salt-bridging sodium hexametaphosphate with di- or tritopic guanidinium sulfate in water forms a cross-linked supramolecular network, which is stable unless electrolytes are resupplied. This unusual stability is caused by a liquid-liquid phase separation that expels sodium sulfate, generated upon salt bridging, into a water-rich phase. Drying the remaining condensed liquid phase yields glassy plastics that are thermally reshapable, such as thermoplastics, and usable even in aqueous media with hydrophobic parylene C coating. This approach can be extended to polysaccharide-based supramolecular plastics that are applicable for three-dimensional printing. more...

Ferroelectric nematic liquid crystals (N F LCs) are distinguished by their remarkable polarization characteristics and diverse physical phenomena, sparking significant interest and excitement within the scientific community. To date, over 150 N F LC molecules are developed; however, there are no reports regarding straight linear polar molecules with a parallel alignment of the permanent dipole moment and the molecular axis. The straight polar mesogen nBOE exhibits an enantiotropic N F phase with a wide temperature window (up to 100 K) despite having a longer alkyl chain (up to n = 6) than the critical alkyl chain length of conventional models. Interestingly, nBOE with a medium-length alkyl chain displays an exotic phase sequence of N F - HC N F -SmX F during the elimination of positional displacement among adjacent molecules. Furthermore, the reflective color modulation of the HC N F LC over the entire VIS-NIR spectral regime by ultralow E-field (up to 0.14 V µm -1 ) is demonstrated., (© 2024 The Author(s). Advanced Science published by Wiley‐VCH GmbH.) more...

Background: The intracytoplasmic sperm injection (ICSI) technique has low efficiency in cattle. This has mainly been attributed to the oocyte activation failure due to oocyte and/or sperm factors., Aim: Our aim was to evaluate the effect of conventional ICSI and Piezo-ICSI with bull or human sperm on bovine oocyte activation and embryo development and to assess its relationship with the phospholipase C zeta (PLCɀ) activity of both species., Methods: In vitro matured bovine oocytes were randomly divided into five groups and were fertilized as follows: conventional ICSI using bovine sperm with chemical activation (control), conventional ICSI using bovine sperm, Piezo-ICSI using bovine sperm, conventional ICSI using human sperm, and Piezo-ICSI using human sperm. PLCɀ activity was determined in bull and human sperm samples., Results: Within the groups using bull sperm, the oocytes fertilized by conventional ICSI had the lowest values of 2 pronuclei (PN) formation and cleavage, Piezo-ICSI increased both percentages and ICSI + chemical activation presented the highest 2 PN, cleavage, and blastocyst rates ( p < 0.05). Within the groups using human sperm, the oocytes fertilized by Piezo-ICSI presented higher 2 PN and cleavage rates than those activated by conventional ICSI ( p < 0.05). Piezo-ICSI with human sperm increased bovine oocyte activation as much as conventional ICSI + chemical activation with bovine sperm ( p < 0.05). Higher values of PLCɀ activity were found in human sperm compared with bovine sperm ( p < 0.05)., Conclusion: Our results suggest that the higher stability of the bovine sperm in combination with its relatively low content of PLCɀ impairs bovine oocyte activation after ICSI., Competing Interests: The authors have declared that there is no conflict of interest concerning this study. more...

An 80-year-old woman had developed a slight fever and loss of appetite since October 20XX. In November of the same year, the patient visited our hospital. Peripheral blood tests revealed the presence of atypical lymphocytes and a significant increase in sIL-2R. Tests of bone marrow aspiration samples showed the infiltration of small lymphocytes positive for CD19, CD20, CD23, and lambda. Therefore, a diagnosis of small lymphocytic lymphoma(SLL)was made. A complex karyotype including -X and del(13q)was observed in 19/20. Additionally, an enlarged spleen and retroperitoneal tumors were observed. As a result of 3 courses of fludarabine plus rituximab therapy, atypical lymphocytes were no longer observed in the peripheral blood and the enlarged spleen decreased in size. However, the retroperitoneal tumors could not be reduced. Consequently, a needle biopsy from the same area was performed in February 20XX+1, and a diagnosis of diffuse large B-cell lymphoma(DLBCL)was made. Because massive infiltration of CD23-negative lymphocytes was observed in the bone marrow, it was suggested that chronic lymphocytic leukemia(CLL)had transformed into DLBCL. Following 4 courses of CHOP therapy, the retroperitoneal tumors were reduced. In cases where -X is a microclone, the mutation is often age-related. However, in cases of advanced chronogenesis, as occurred in this patient, a correlation with hematopoietic tumors is arguable. Moreover, cases of CLL with -X have been reported to be related to de(l 13q). Our results strongly suggest that -X with del(13q)may be a clonal expansion in CLL/SLL. more...

Fluorinated cycloparaphenylenes (FCPPs) have attracted attention as electron-accepting CPPs as well as strained fluoroarenes. Herein, we report the synthesis and properties of novel FCPPs; F ipt>16 [8]CPP and F 12 [6]CPP. Furthermore, the derivatization of F 16 [8]CPP afforded a new carbon nanoring where sixteen pyrrole rings are densely substituted on the CPP framework. more...

We surveyed the facilities that were members of the Japan Association of Zoos and Aquariums to clarify the incidence of aspergillosis, which is a major cause of death in captive penguins, and to discern effective preventive measures. Responses were obtained for 2910 penguins in 64 facilities; 73 penguins (2.5%) in 35 facilities had died from aspergillosis during the past 5 years from April 2016 to March 2021. Answers to questions about the rearing environment indicated that aspergillosis occurred significantly more often in facilities where penguins were reared outdoors, were in contact with soil, or were moved outside of the rearing enclosure. Answers to questions about their dead penguins indicated that 76% may have been at individual risk (e.g., young age, old age, molting period, and breeding season) and 54% were thought to be reared in uncomfortable environments (e.g., high temperature, high humidity). Aspergillosis may occur when individual risk factors and uncomfortable environmental factors are added to the risk factors of exposure to Aspergillus , such as the presence of soil. These conditions must be recognized as risk factors for aspergillosis, and appropriate preventive measures, such as avoiding penguin contact with the soil where Aspergillus is expected to be present, can minimize aspergillosis-related deaths. more...

Laser speckle flowmetry (LSF) can measure moving red blood cells in real time as changes in tissue blood flow; however, LSF values may not be sufficiently reproducible due to body movements and other factors. Therefore, it is difficult to compare absolute values of LSF directly. This study aimed to verify the influence of head fixation on improving the measurement accuracy and enabling the comparison of LSF values semi-quantitatively using an external standard. We first examined the effects of head fixation on LSF values obtained during cerebral blood flow (CBF) measurement through a bone window over the cerebrum in Sprague-Dawley rats. The LSF values in the bone window were semi-quantitated using the ratio of the external standard LSF values measured simultaneously in the same field of view in a unilateral common carotid artery ligation model to evaluate CBF. Head fixation halved the variability of LSF values when compared with measurements made without head fixation. The LSF laser focus position did not affect the LSF values provided the focus was positioned within the exposed cranium. Semi-quantitation of LSF values made it possible to monitor changes in CBF in each respective bone window over time in a model of unilateral carotid ligation. In conclusion, the stabilizing effect of head fixation on LSF values was clarified, and we observed that to improve measurement accuracy, the head should be immobilized. Semi-quantitation of LSF values was first introduced by using an external standard and appears to be useful in monitoring the CBF of each location separately., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023. Published by Elsevier B.V.) more...

Perfluorinated aromatic compounds, the so-called perfluoroarenes, are widely used in materials science owing to their high electron affinity and characteristic intermolecular interactions. However, methods to synthesize highly strained perfluoroarenes are limited, which greatly limits their structural diversity. Herein, we report the synthesis and isolation of perfluorocycloparaphenylenes (PFCPPs) as a class of ring-shaped perfluoroarenes. Using macrocyclic nickel complexes, we succeeded in synthesizing PF[n]CPPs (n = 10, 12, 14, 16) in one-pot without noble metals. The molecular structures of PF[n]CPPs (n = 10, 12, 14) were determined by X-ray crystallography to confirm their tubular alignment. Photophysical and electrochemical measurements revealed that PF[n]CPPs (n = 10, 12, 14) exhibited wide HOMO-LUMO gaps, high reduction potentials, and strong phosphorescence at low temperature. PFCPPs are not only useful as electron-accepting organic materials but can also be used for accelerating the creation of topologically unique molecular nanocarbon materials., (© 2022. The Author(s).) more...

This is the first report of the double primary cancer of esophageal cancer (EC) and myelodysplastic syndromes (MDS) treated without esophagectomy. Previously reported cases of the double cancer mostly describe secondary MDS arising after treatment for EC. The double primary cancer was manageable with close follow-ups for possible recurrence., Competing Interests: The authors declare that we have no competing interests., (© 2021 The Authors. Clinical Case Reports published by John Wiley & Sons Ltd.) more...

(Introduction)HoLEP's role in the surgical management of benign prostatic hyperplasia (BPH) is steadily growing. In this study, a questionnaire containing questions about perioperative management was submitted to HoLEP surgeons to help establish standard surgical training procedures. (Methods)We sent a comprehensive 17 questionnaires on HoLEP procedures to 18 surgeons. The questionnaire asked, "Which method are you using, the 1-LOBE or 3-LOBE method?", "What educational methods are being used for surgeons?", "How long is the catheter insertion period after HoLEP?", and "What is the most difficult problem encountered in surgical HoLEP education and what aspect of training is the most emphasized?" (Results)Sixteen (88.9%) surgeons answered these questionnaires. Five surgeons reported using the one lobe method, five surgeons reported using the three lobe method, and four surgeons answered that it depends on the case. Regarding educational methods, the main answer was that it is important to evaluate pre-HoLEP imaging tests such as MRI and cystoscopy and to simulate surgery for education. Regarding the postoperative catheter insertion period, 1 day: 1 surgeon, 2 days: 9 surgeons, 3 days: 3 surgeons, 4 days or more: 1 surgeon. The most important thing reported for surgical education was to help beginners understand the characteristics of lasers, including direction, distance to prostate tissue, and adenoma removal. (Conclusions)The surgeons' responses clearly indicated some differences in practices between institutions. More detailed data from these results will provide a step towards designing standardized surgical and educational protocols for HoLEP. more...

The synthesis of each of the cycloiptycene derivatives was achieved in one step from the (6,6)carbon nanobelt. It was revealed that the carbon nanobelt reacted as a diene in the Diels-Alder reaction with arynes and alkynes. The structures of all products were identified by X-ray crystallography to confirm that the Diels-Alder reactions took place at the six central benzene rings of the carbon nanobelt. DFT calculations indicated that the release of strain energy is the driving force to promote the Diels-Alder reaction. By using this method, we have successfully synthesized cyclotetracosiptycene, the largest iptycene ever synthesized., (This journal is © The Royal Society of Chemistry 2020.) more...

A catenane consisting of two [9]cycloparaphenylenes ([9]CPPs) has been synthesized. Density functional theory calculations suggested that [ n ]CPPs ( n = 5, 6) are highly strained upon the formation of catenanes compared with the corresponding uncatenated CPPs, whereas [ n ]CPP catenanes ( n ≥ 7) are not strained. The synthesis of ([9]CPP)([9]CPP)catenane was accomplished via the following route: (i) a spirosilylation, (ii) a nickel(0)-mediated macrocyclization, (iii) a desilylation, and (iv) reductive aromatization reactions. An X-ray diffraction analysis revealed a catenated structure of ([9]CPP)([9]CPP)catenane. more...

Epstein-Barr virus (EBV)-associated gastric cancer (GC) is associated with a high degree of DNA methylation. However, the association between chemotherapy susceptibility and tumor DNA methylation in advanced diseases remains unclear. The comprehensive DNA methylation status of GC cells obtained from an advanced EBV-associated GC (EBVGC) case, in which complete response to S-1 plus cisplatin chemotherapy was achieved, was analyzed using a DNA methylation microarray. We compared DNA methylation of GC cells with public data and identified genes with higher methylation in EBVGC cell lines than in normal gastric cells, and genes in which methylation was increased by EBV. Of these genes, ABCG2, AHNAK2, BCL2, FZD1, and TP73 are associated with published evidence for resistance to 5-fluorouracil and cisplatin. Silencing of these genes may be associated with hypersensitivity to chemotherapy., (© 2019 The Authors. Published by FEBS Press and John Wiley & Sons Ltd.) more...

There is a clinical demand for efficient cryopreservation of cloned camel embryos with considerable logistic and economic advantage. Vitrification of in vivo derived embryos has been reported in camels, but there is no study on vitrification of cloned embryos. Moreover, whether characteristic differences between cloned and in vivo derived embryos imply different vitrification requirement is unresolved. Here, we compared survival, re-expansion and pregnancy rates of cloned embryos vitrified using two commercial vitrification kits (Cryotec and Kitazato), developed basically for human embryos, and a vitrification protocol developed for in vivo camel embryos (CVP). Cloned embryos responded dynamically to vitrification-warming steps in commercial kits, with a flat shrinkage in the final vitrification solution and a quick re-expansion to the original volume immediately after transferring to the isotonic warming solution. Contrarily, full shrinkage was not observed in CVP method, and majority of embryos were still collapsed post-warming. The immediate re-expansion was highly associated and predictive of higher survival and total cell number, and also better redox state of embryos vitrified by Cryotec and Kitazato kits compared to CVP method. Importantly, while 30% blastomere loss, verified by differential dye exclusion test, was tolerated in vitrified embryos, >50% blastomeres loss in non-expanded blastocysts implied the minimal essential cell survival rate for blastocoelic cavity re-expansion in vitrified cloned camel blastocysts, irrespective of vitrification method. A protocol-based exposure of embryos to cryoprotectants indicated that cryoprotectant toxicity, per se, may not be involved in lower cryosurvival of embryos in CVP vs. Cryotec and Kitazato. The initial pregnancy rates were numerically higher in Cryotec and Kitazato frozen transfers compared to fresh transfer (56.3, 60 and 33.3%, respectively), and importantly, a higher percentage of established pregnancies in vitrified groups passed the critical 3 months period of early embryonic loss compared to sibling fresh clone pregnancies (50, 40, and 10%, respectively). Results confirmed the suitability of Cryotec and Kitazato kits for vitrification of cloned camel embryos and that vitrification may improve pregnancy outcome by weeding out poor competent embryos., (Copyright © 2019 Elsevier Inc. All rights reserved.) more...

The regioselective ten-fold borylation of warped nanographene (WNG: C 80 H 30 ) was achieved by modifying the reaction conditions of a previously reported Ir-catalyzed C-H borylation, affording decaborylated WNG in high yield (75%) from pristine WNG. The solid-state structure of decaborylated WNG was confirmed by X-ray crystallography. Corresponding decaarylated WNGs containing electron-withdrawing and -donating groups were synthesized from decaborylated WNG using Suzuki-Miyaura cross-coupling reactions to afford the red-emissive warped nanographene derivative., (This journal is © The Royal Society of Chemistry 2019.) more...

The generation of topologically complex nanocarbons can spur developments in science and technology. However, conventional synthetic routes to interlocked molecules require heteroatoms. We report the synthesis of catenanes and a molecular trefoil knot consisting solely of para -connected benzene rings. Characteristic fluorescence of a heterocatenane associated with fast energy transfer between two rings was observed, and the topological chirality of the all-benzene knot was confirmed by enantiomer separation and circular dichroism spectroscopy. The seemingly rigid all-benzene knot has rapid vortex-like motion in solution even at -95°C, resulting in averaged nuclear magnetic resonance signals for all hydrogen atoms. This interesting dynamic behavior of the knot was theoretically predicted and could stimulate deeper understanding and applications of these previously untapped classes of topological molecular nanocarbons., (Copyright © 2019 The Authors, some rights reserved; exclusive licensee American Association for the Advancement of Science. No claim to original U.S. Government Works.) more...

This study was conducted to examine the utility of vitrification for bovine embryos with low-quality grade, and simple cryoprotectants dilution method for practitioners. In Experiment 1, survival of frozen embryos was compared with that of vitrified embryos using minimum volume cooling (MVC). Then, vitrified embryos were used to confirm the optimum sucrose concentration in Experiment 2. The survival rates of embryos that had been vitrified following diluted cryoprotectants with the one-step in-straw method were compared with those of fresh control embryos in Experiment 3. Frozen-thawed or vitrified-warmed blastocysts were cultured with TCM-199 supplemented with 100 μmol/L beta-mercaptoethanol +5% fetal bovine serum at 38.5°C in an atmosphere of 5% CO 2 in air, their survival after 24 hr were compared. The development to term of fair quality in vivo embryos after vitrification was examined in Experiment 4. Results show that survival rates of frozen-thawed embryos were lower (p < .05) than that of vitrified-warmed ones. When vitrified embryos were warmed in 0.3 mol/L sucrose in straws, their survival rate was 100%. The total cell numbers of vitrified-warmed embryos were comparable to those of fresh control embryos. The six calves from 13 vitrified embryos were delivered in Experiment 4. These results indicate that MVC vitrification following one-step cryoprotectants dilution is utilized to preserve low-quality bovine embryos., (© 2018 Japanese Society of Animal Science.) more...

Background: Patients with advanced gastric cancer (AGC) are often treated with irinotecan monotherapy as salvage-line therapy. However, the survival benefit of this therapy remains to be elucidated., Methods: Medical records of AGC patients who were treated with irinotecan monotherapy as salvage-line treatment in six institutions from 2007 to 2014 were reviewed., Results: A total of 146 patients had prior fluoropyrimidine and taxane therapies, and 75.3% had prior platinum therapy. The median age was 66 (range 27-81) years, and 102 males (69.9%) were included. Performance status (PS) was 0/1/2/3 in 53/70/19/4 patients. Eighty-nine patients (61.0%) had two or more metastatic sites. Irinotecan monotherapy as 3rd-/4th-line therapy was performed in 135/11 (92.5%/7.5%). The median number of administrations was 4 (range 1-62). Forty-six patients (31.5%) required initial dose reduction at the physician's discretion. The overall response rate was 6.8%, and the disease control rate was 43.1%. The median PFS was 3.19 months [95% confidence interval (CI) 2.30-4.08 months], and the median OS was 6.61 months (95% CI 5.94-7.28 months). Grade 3/4 adverse events were hematological toxicity (46 patients, 31.5%) and non-hematological toxicity (50 patients, 34.2%). Hospitalization due to adverse events was required in 31 patients (21.2%). Patients with relative dose intensity (RDI) less than 80% showed similar survival to those with RDI 80% or higher., Conclusions: Irinotecan monotherapy was relatively safely performed as salvage-line treatment for AGC in Japanese clinical practice. Careful patient selection and intensive modification of the dose of irinotecan might possibly be associated with favorable survival. more...

Background: Significant efficacy of oxaliplatin-based chemotherapy has been demonstrated for advanced gastric cancer (AGC). However, the appropriate dose of oxaliplatin, and the efficacy and toxicity of administration of oxaliplatin subsequent to cisplatin therapy still remain unclear., Patients and Methods: In total, 55 patients with AGC that were scheduled to receive oxaliplatin-based chemotherapy were prospectively examined., Results: The median age was 67 years and oxaliplatin was administered to 39 (71%) patients as first-line and in 16 (29%) patients as second-line therapy. An initial dose of 130 or 100 mg/m 2 of oxaliplatin was administered to 11 and 36 patients, respectively. The overall response rates (ORR) and median progression free survival (mPFS) were 86 and 33%, and 7.2 and 7.8 months, respectively. Compared to 100 mg/m 2 , the relative dose intensity was significantly lower and severe toxicity tended to increase with oxaliplatin at 130 mg/m 2 A total of 10 patients (18%) had a prior cisplatin-based therapy. The ORR of the patients pretreated with cisplatin was 14% and the mPFS was 6.1 months., Conclusion: An initial oxaliplatin dose of 130 mg/m 2 resulted in a good response, but tended to increase the risk of toxicity. Subsequent oxaliplatin-based therapy after cisplatin exhibited modest efficacy, especially in cases with cisplatin intolerance., (Copyright© 2017, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.) more...

In the last 15-20 years, many centers are using vitrification as a method of choice for cryopreservation of human oocytes and embryos. As vitrification technologies have improved their success profiles, new applications seem to have emerged, making IVF treatments more successful and more flexible.This appendix describes the Cryotech ® method, which is the latest "minimal volume approach" method, suitable for cryopreservation of oocytes and embryos of any developmental stage, including blastocysts. Dr. Masashige Kuwayama, who has introduced major advances in oocyte and embryo cryopreservation, has developed this method. A detailed protocol has been described with finer tips for the accurate use of the method for perfect survival and safety. more...

Colorectal cancer (CRC) has a propensity to metastasize to the liver, lungs and regional abdominal lymph nodes, but rarely to the bone marrow. A 60-year-old man presented to the National Hospital Organization Kyushu Cancer Center with a 4-week history of persistent lower back pain, anorexia and difficulty defecating. Complete blood count revealed severe thrombocytopenia and erythroblastosis, suggesting a hematological malignancy. However, the bone marrow examination demonstrated involvement by a moderately to poorly differentiated adenocarcinoma, but no hematopoietic abnormalities. A computed tomography scan revealed thickening of the wall of the sigmoid colon, with para-aortic, hilar, mediastinal and supraclavicular lymphadenopathy. The patient was thus diagnosed with sigmoid colon adenocarcinoma with lymph node and bone marrow metastasis. Modified FOLFOX6 was promptly initiated, with concurrent therapy for disseminated intravascular coagulation (DIC). An increased number of thrombocytes was observed on day 6. After 3 cycles of treatment, the patient recovered from DIC and the levels of serum carcinoembryonic antigen and cytokeratin 19 fragment were decreased. Tumor biopsy during colonoscopy following recovery from DIC demonstrated poorly differentiated adenocarcinoma with mucin production, without mutations in the RAS , BRAF or PIK3CA genes, and a cytokeratin (CK) 7-negative, CK20-positive phenotype. The patient has been treated with chemotherapy for 150 days without disease progression. However, the efficacy of chemotherapy for rarely encountered bone marrow metastasis from CRC is poor. The present case was favorably maintained on chemotherapy and survived for 10 months. more...

A simple yet effective method for the formation of thiophene-fused π-systems is reported. When arylethynyl-substituted polycyclic arenes were heated in DMF in the presence of elemental sulfur, the corresponding thiophene-fused polycyclic arenes were obtained via cleavage of the ortho-C-H bond. Thus, arylethynylated naphthalenes, fluoranthenes, pyrenes, corannulenes, chrysenes, and benzo[c]naphtho[2,1-p]chrysenes were effectively converted into the corresponding thiophene-fused π-systems. Apart from polycyclic hydrocarbons, thiophene derivatives are also susceptible to this reaction. The practical utility of this reaction is demonstrated by preparations on the decagram scale, one-pot two-step reaction sequences, and multiple thiophene annulations. more...

A 75-year-old man diagnosed with ileal gastrointestinal tumor with peritoneal dissemination was subjected to salvage treatment with regorafenib at 120 mg/day. Following the initiation of the treatment, liver dysfunction appeared on day 28, and continued to worsen despite termination of the treatment. Since no increase in the levels of serum immunoglobulins of the patient was observed, and negative results were obtained for the analysis of viral markers and autoantibodies, a diagnosis of regorafenib-induced hepatitis was suggested. In consequence, the patient received steroid pulse therapy and continuous administration of prednisolone, without sufficient improvement. Liver biopsy revealed interface hepatitis with prominent plasma cell infiltration, suggesting regorafenib-induced autoimmune hepatitis. The patient was then administered azathioprine and prednisolone, which improved the hepatic injury. The present case represents the first report of successful treatment of regorafenib-induced severe hepatic injury by the use of an immunosuppressant. more...

Cancer of unknown primary origin (CUP) which is usually diagnosed based on the histological type of metastatic site has marked heterogeneous characteristics. Sarcomatoid carcinoma defined as CUP has not been reported according to our literature survey. A 59-year-old man presented with enlarged multiple thoracic lymph nodes, huge splenomegaly and nodules in left temporal lobe of the brain. The histopathological diagnosis of lymph node and spleen was sarcomatoid carcinoma. However, all extensive diagnostic examinations could not detect a site of primary origin. The laboratory data showed marked leukocytosis with increased serum granulocyte colony-stimulating factor (G-CSF). Therefore, the patient was finally diagnosed of CUP of sarcomatoid carcinoma producing G-CSF. After gamma knife treatment for brain metastases, two regimens of taxan-based chemotherapy (carboplatin and paclitaxel, gemcitabine and docetaxel) were administered, with no effect but further tumor progression. Splenectomy for avoiding splenic rupture was performed. As the third line chemotherapy, the combination consisting of doxorubicin and ifosfamide was administered and showed a good therapeutic effect and normalized white blood cell count and serum G-CSF level. He achieved complete remission after three cycles. Herein we present an extremely rare case of CUP of sarcomatoid carcinoma producing G-CSF. Our case suggests the importance of chemotherapy including doxorubicin and ifosfamide, and multimodal therapeutic strategy for this aggressive disease. more...