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Periodontal tissue homeostasis depends on a complex cellular network that conveys cell-cell communication. Gap junctions (GJs), one of the intercellular communication systems, are found between adjacent human periodontal ligament (hPDL) cells; however, the functional GJ coupling between hPDL cells has not yet been elucidated. In this study, we investigated functional gap-junction-mediated intercellular communication in isolated primary hPDL cells. SEM images indicated that the cells were in contact with each other via dendritic processes, and also showed high anti-connexin43 (Cx43) immunoreactivity on these processes. Gap-junctional intercellular communication (GJIC) among hPDL cells was assessed by fluorescence recovery after a photobleaching (FRAP) analysis, which exhibited dye coupling between hPDL cells, and was remarkably down-regulated when the cells were treated with a GJ blocker. Additionally, we examined GJs under hypoxic stress. The fluorescence recovery and expression levels of Cx43 decreased time-dependently under the hypoxic condition. Exposure to GJ inhibitor or hypoxia increased RANKL expression, and decreased OPG expression. This study shows that GJIC is responsible for hPDL cells and that its activity is reduced under hypoxia. This is consistent with the possible role of hPDL cells in regulating the biochemical reactions in response to changes in the hypoxic environment.

This study sought to compare the 2-year outcomes between bioresorbable vascular scaffold (BVS) and everolimus-eluting metallic drug-eluting stent (EES).The occurrence of very late stent/scaffold thrombosis (VLST) of BVS beyond 1 year after implantation is an increasing concern.We conducted a meta-analysis of 24 studies (BVS: n = 2,567 and EES: n = 19,806) reporting the 2-year outcomes of BVS and/or EES to compare the risk of BVS versus EES for stent/scaffold thrombosis (ST) and target lesion failure (TLF) in 7 comparative studies (3 randomized and 4 observational), and to estimate the pooled incidence rates of ST and TLF including additional 17 single-arm studies.In the 7 comparative studies, the risk for VLST between 1 and 2 years was numerically higher in BVS than in EES (odds ratio [OR]: 2.03 [95% confidence interval (CI): 0.62 to 6.71]). The excess risk of BVS relative to EES for ST through 2 years was significant (OR: 2.08 [95% CI: 1.02 to 4.26]). The risk for TLF was neutral between BVS and EES. In the 24 studies, the pooled estimated incidence rates of VLST, and ST through 2 years were higher in BVS than in EES (0.240 [95% CI: 0.022 to 0.608]% vs. 0.003 [95% CI: 0.000 to 0.028]%, and 1.43 [95% CI: 0.67 to 2.41]% vs. 0.56 [95% CI: 0.43 to 0.70]%, respectively). The corresponding rates for TLF were comparable between BVS and EES (1.88 [95% CI: 1.30 to 2.55]% and 1.78 [95% CI: 1.17 to 2.49]% and 7.90 [95% CI: 6.26 to 9.69]% and 7.49 [95% CI: 5.86 to 9.29]%, respectively).In this meta-analysis, BVS as compared with EES was associated with higher risk for VLST between 1 and 2 years and ST through 2 years.

We herein report a case of a 52-year-old woman who presented with a history of recurrent palpitations that occurred during swallowing solid food. On a Holter electrocardiogram, paroxysmal atrial tachycardias (PATs) were detected while eating. We mapped the right atrium (RA) with a multipolar mapping catheter while she swallowed a rice ball and it was revealed that the earliest endocardial breakthrough was on the anterior septal side near the superior vena cava junction of the RA. We successfully eliminated PAT at both the site in the RA and the adjacent right superior pulmonary vein ostium. After ablation, no PAT was documented while eating.

A 60-year-old man was admitted due to the onset of right coronary artery (RCA) aneurysms. Coronary angiography showed two RCA aneurysms and focal stenosis with limitations in the blood flow. Balloon angioplasty was performed. However, the follow-up coronary angiography showed restenosis, an enlarged proximal aneurysm and a newly formed aneurysm. The serum immunoglobulin G4 level was elevated to 1,350 mg/dL and fluorodeoxyglucose positron emission tomography showed increased uptake in the ascending aorta, so the patient was diagnosed with immunoglobulin G4-related vascular disease. The prevention of further enlargement of the aneurysms and an improvement in the RCA flow were achieved with steroid therapy. Steroid therapy may therefore be effective for immunoglobulin G4-related vascular disease.

Objective:To investigate dental appearance and cephalometric features, using a sample of orthognathic and/or orthodontic patients. A special interest was to identify the relationship of the Dental Aesthetic Index (DAI) with anteroposterior basal bone discrepancy (APBBD) and cephalometric indicators.Materials and Methods:A full sample of 159 patients in two Japanese hospitals was used. Each patient was assessed with a preorthodontic dental cast and cephalometric radiography.Results:Malocclusion with APBBD was more prevalent among high DAI subjects (P = .034, OR = 1.04, 95% CI: 1.00–1.08), Class III malocclusion patients (P = .048, OR = 2.32, 95% CI: 1.01–5.34) and male patients (P = .008, OR = 2.96, 95% CI: 1.33–6.61). Participants scoring 88 points (the highest score in this sample) of the DAI had 16.84 times the risk of APBBD of those who scored 17 points (the lowest score in this sample). Patients with APBBD presented with a greater adjusted ANB angle (t = −8.10, P < .001) and a larger adjusted A-B/NF appraisal (t = −9.65, P < .001). The SNA angle (P < .001), the SNB angle (P = .002), the adjusted ANB angle (P = .001), and the adjusted A-B/NF appraisal (P = .035) were associated with DAI scores in cubic regression models.Conclusion:This study has demonstrated a relationship between the DAI and APBBD. Feasibility of using the adjusted ANB angle and the adjusted A-B/NF appraisal to assess severity of APBBD has been confirmed. The DAI may provide a supportive method to evaluate orthognathic needs. Future investigations are indicated.

Schwannomas are benign tumors that arise from neural sheath Schwann cells. Solitary benign schwannoma is generally located in the head and neck and is a rare neoplasm among the tumors of the retroperitoneal space. Reports of laparoscopic excision of retroperitoneal schwannomas have recently been on the increase. However, few cases of single-port laparoscopic excision of these tumors have been reported. Moreover, there are no reports of single-port excision of schwannomas attached to the body of pancreas and around the splenic vessels. This is the first report of a schwannoma lying adjacent to the body of the pancreas between the splenic artery and vein that was excised by single-port laparoscopic surgery. The most notable aspect of our procedure is the use of bipolar forceps. Single-port laparoscopic excision using bipolar forceps is a feasible and safe procedure for retroperitoneal solitary tumors, even when they are close to the splenic artery and vein.

Epidrum(®) is an optimal pressure, loss of resistance device for identifying the epidural space. We investigated the usefulness of Epidrum versus the loss of resistance or hanging drop techniques while performing epidural anesthesia. Eighty adult patients who were scheduled for elective surgery under lumbar epidural anesthesia were randomized into two groups. The first group (Epidrum group) consisted of 40 adult patients who were scheduled for epidural anesthesia using Epidrum. The second group (control group) consisted of 40 adult patients who were scheduled for epidural anesthesia using the loss of resistance or hanging drop technique. We recorded the time required to identify the epidural space and outcomes of epidural catheterization. The attending anesthesiologists were also questioned regarding the ease of control of the Tuohy needle and of epidural space identification with each method. The time required to perform epidural anesthesia was significantly shorter in the Epidrum group than in the control group [28 s (10-76) vs. 90 s (34-185); median (interquartile range)] (p 0.05). Tuohy needle control was significantly easier in the Epidrum group than in the control group (p 0.05). Epidrum is useful for performing epidural anesthesia quickly while obtaining good Tuohy needle control.

Aim Severe gastrointestinal bleeding sometimes occurs in patients with aortic stenosis (AS), known as Heyde's syndrome. This syndrome is thought to be caused by acquired von Willebrand syndrome and is characterized by reduced large von Willebrand factor (vWF) multimers. However, the relationship between the severity of AS and loss of large vWF multimers is unclear. Methods We examined 31 consecutive patients with severe AS. Quantitative evaluation for loss of large vWF multimers was performed using the conventional large vWF ratio and novel large vWF multimer index. This novel index was defined as the ratio of large multimers of patients to those of controls. Results Loss of large vWF multimers, defined as the large vWF multimer index ＜80%, was detected in 21 patients (67.7%). The large vWF multimer ratio and the large vWF multimer index were inversely correlated with the peak aortic gradient (R = -0.58, p=0.0007, and R=-0.64, p＜0.0001, respectively). Anemia defined as hemoglobin ＜9.0 g/dl was observed in 12 patients (38.7%), who were regarded as Heyde's syndrome. Aortic valve replacement was performed in 7 of these patients, resulting in the improvement of anemia in all patients from a hemoglobin concentration of 7.5±1.0 g/dl preoperatively to 12.4±1.3 g/dl postoperatively (p＜0.0001). Conclusions Acquired von Willebrand syndrome may be a differential diagnosis in patients with AS with anemia. The prevalence of AS-associated acquired von Willebrand syndrome is higher than anticipated.

Sleep-disordered breathing (SDB) is recognized as a primary factor or mediator of atrial fibrillation (AF). We hypothesized that the severity of SDB among AF ablation candidates would be associated with left ventricular diastolic dysfunction (LVDD) even for subclinical SDB. A total of 246 patients hospitalized for initial pulmonary vein isolation (PVI) were analyzed. Known SDB cases were excluded. We measured the oxygen desaturation index (ODI) by pulse oximetry overnight as an indicator of SDB, and classified SDB severity by 3 % ODI as normal (ODI

Anastomotic leakage (AL) is a critical complication of colorectal cancer surgery. The transanal drainage tube (TDT) is designed to prevent AL caused by decompression and stasis at the anastomosis. We conducted this study to investigate the feasibility of using the TDT to prevent AL following double-stapling technique reconstruction (DST). The subjects of this study were 179 patients who underwent curative resection and DST reconstruction for sigmoid colon and rectal cancer in our institution between 2008 and 2013. We analyzed the effectiveness of the TDT for preventing AL. A TDT was placed in 78 patients (43.6 %, TDT group) and not placed in the remaining 101 patients (56.4 %, NTDT group). AL developed in 2 (2.6 %) patients from the TDT group and in 14 (13.9 %) patients from the NTDT group (p = 0.009). Univariate analysis revealed that AL was significantly correlated with tumor distance from the anal verge (AV), the number of staples, and TDT placement. Multivariate analysis revealed a significantly positive correlation between AL and AV [OR 0.877 (0.783–0.982) p = 0.023] and a significantly negative correlation between AL and TDT placement [OR 0.07 (0.013–0.374) p = 0.002]. Anastomotic decompression with TDT placement may prevent AL after colorectal cancer surgery with DST reconstruction.

As long as the perfluorinated proton exchange membrane (PEM) is used for the electrolyte, both the cell performance and life are highly dependent upon the water content in the electrolyte. On the other hand, pre-humidification of fuel and oxidant gases complicates the PEMFC system and prevents it from possible cost reduction measures. In this study, in order to maintain a membrane electrode assembly (MEA) with a satisfactory water content by only the water produced in catalyst layer through the electrode reaction without prior humidification of both the fuel and oxidant gases, a novel gas diffusion layer (GDL) was fabricated. This was achieved by coating a water management layer (WML) onto a traditional GDL in order to place the WML between the traditional GDL and the catalyst layer of the PEMFC. This study describes the significant balance of water with WML in the fuel cell using both simulation and experimental analysis.

A 2520 h lifetime test of a single proton exchange membrane (PEM) fuel cell under low humidification (65.8% relative humidity for both anode and cathode feed stream) at a low current density of 200 or 300 mA cm−2 was conducted. H2 crossover rate through electrolyte membrane and open circuit voltage of the cell with time were measured to understand the membrane degradation in the membrane electrode assembly (MEA) during the life test. The results show that low humidification of feed stream accelerates membrane physical degradation, and results in membrane pin-holes and reactant gas crossover. A novel sub-cell approach coupled with SEM and TEM were employed as post mortem analyses. The performance of the sub-cell at H2 inlet region is unacceptably lower than that at the H2 outlet region. SEM images of the used MEA in cross-section apparently revealed that membrane thinning occurred mainly at the H2 inlet region. TEM analysis of the electrocatalysts in the pre- and post-test cell demonstrated that the agglomeration of the Pt particles took place both at the anode and the cathode. Therefore, the non-uniform degradation of electrolyte membrane and the agglomeration of Pt catalysts are concurrently responsible for the degraded performance of the PEM fuel cell.

We report a case of a 60-year-old man with recurrent poly- and monomorphic ventricular tachycardia related to a recent myocardial infarction. Due to drug-refractory ventricular tachycardia despite complete revascularization, he underwent catheter ablation. Afterwards, he was fitted with a wearable cardioverter defibrillator. Three months later, no ventricular tachycardia had been recorded and an electrophysiologic study failed to induce an episode. Thus, wearable cardioverter defibrillators are useful bridging devices pending a final decision to implant a cardioverter defibrillator.

Staging System sixth edition. The patient did not have peritoneal or liver metastases. Based on the clinical presentation, TEE, and histopathology findings, the masses in the thoracic aorta were considered to be thrombi and thought to be the causative factor for the rectal perforation. Postoperative hematologic testing revealed protein C deficiency: Initial activity value, 32% (normal value, 64%-146%), and initial antigen value, 33% (normal value, 70%-150%). The patient did not have a medical history of protein C deficiency. Factor VIII, homocysteine and protein S activity, and antigen levels were within normal ranges. Anticardiolipin antibody, antinuclear antibody, proteinase-3-antineutrophilic cytoplasmic antibody, myeloperoxidase-antineutrophilic cytoplasmic antibody, and lupus anticoagulant assays all were negative. The patient did not undergo any additional surgery for the aortic thrombi, such as thrombectomy or segmental aortic resection, because it was thought to be too invasive for a patient with advanced cancer. The authors did not perform anticoagulant or thrombolytic therapy because of the significant risk of additional distal embolization. Only oral aspirin was given for aortic thrombus prophylaxis. The patient also received intensive treatment for peritonitis, including antibiotics, fluid management, and mechanical ventilation, after the surgery in the intensive care unit. His clinical course was good, and the aortic thrombi had disappeared completely on a followup CT scan performed on the 49th day of hospitalization (Fig 1B). Cyanosis of the bilateral digits, which was thought to be a sign of acute pedal arterial embolism, appeared during the clinical course, but it improved with intravenous alprostadil monotherapy. The patient was discharged to his home on the 61st day of hospitalization without any other serious distal embolism.

SUMO conjugation is a reversible posttranslational modification that regulates protein function. SENP1 is one of the six SUMO-specific proteases present in vertebrate cells and its altered expression is observed in several carcinomas. To characterize SENP1 role in genome integrity, we generated Senp1 knockout chicken DT40 cells. SENP1(-/-) cells show normal proliferation, but are sensitive to spindle poisons. This hypersensitivity correlates with increased sister chromatid separation, mitotic slippage, and apoptosis. To test whether the cohesion defect had a causal relationship with the observed mitotic events, we restored the cohesive status of sister chromatids by introducing the TOP2α(+/-) mutation, which leads to increased catenation, or by inhibiting Plk1 and Aurora B kinases that promote cohesin release from chromosomes during prolonged mitotic arrest. Although TOP2α is SUMOylated during mitosis, the TOP2α(+/-) mutation had no obvious effect. By contrast, inhibition of Plk1 or Aurora B rescued the hypersensitivity of SENP1(-/-) cells to colcemid. In conclusion, we identify SENP1 as a novel factor required for mitotic arrest and cohesion maintenance during prolonged mitotic arrest induced by spindle poisons.

We investigated the efficacy of glucose infusion for the inhibition of breakdown of fat tissue and muscle protein under remifentanil anesthesia.Twenty adult patients (ASA I or II) were enrolled in this study and randomized into two groups: a control group receiving acetated Ringer's solution without glucose (n = 10) and a glucose group receiving acetated Ringer's solution containing 1% glucose (n = 10). Anesthesia was induced by propofol and fentanyl and maintained by sevoflurane and remifentanil. Plasma concentrations of glucose and cortisol were measured. Acetoacetic acid and 3-hydroxybutyrate acid were measured as parameters for breakdown of fat tissue. Urine 3-methylhistidine/plasma creatinine was measured as a parameter for breakdown of muscle protein during surgery. Data were analyzed by the unpaired t-test, Friedman's chi2-test, Wilcoxon's t-test and Mann-Whitney U test. P0.05 was considered significant.Plasma concentrations of cortisol and glucose were not increased in either group during the study. Plasma concentrations of acetoacetic acid and 3-hydroxybutyrate acid and urine 3-methylhistidine/plasma creatinine significantly increased in the control group but did not increase in the glucose group.Infusion of glucose suppresses breakdown of fat tissue and muscle protein under remifentanil anesthesia.

Background: The Ataxia telangiectasia mutated (ATM) is a serine/threonine protein kinase that is recruited and activated by DNA double-strand breaks. Recently, ATM was reported to correlate with breast cancer metastasis by regulating phosphorylated Snail which was known as a marker of epithelial-mesenchymal transition (EMT), however, it remains unclear in colorectal cancer (CRC). In this study we attempted to clarify the impact of ATM on the mechanism of EMT in CRC. Methods: Potential ATM levels were evaluated in human CRC cells (HT29 and SW480) by qPCR and western blot analysis. Cells were induced EMT by treated with TGF-b, were confirmed by the change of EMT markers (i.e. N-cadherin, E-cadherin, Snail and twist). Next, ATM levels were down-regulated by siRNA and the impact on EMT were evaluated by EMT markers. Invasive potential was evaluated by scratch assay. Results: HT29 showed significantly higher levels of ATM comparing to SW480 (p = 0.042). N-cadherin (p = 0.065), Snail (p = 0.034) and twist (p = 0.052) were highly observed in HT-29, while similar level of E-cadherin in SW480 (p = 0.692). Scratch assay revealed that approximately 4 times high migration was observed in HT29. TGF-b induced EMT such as elevation of N-cadherin and Snail (E-cadherin was not affected), leading to promotion of cell migration in SW480. ATM was successfully 48.4% down-regulated (p = 0.001) in SW480, which resulted in reducing cell migration (p = 0.033). Conclusions: ATM might be a critical regulator of EMT in colorectal cancer invasion. Citation Format: Hidena Takahashi, Masashi Tsuruta, Hirotoshi Hasegawa, Koji Okabayashi, Ryo Seishima, Shimpei Matsui, Toru Yamada, Takayuki Kondo, Takehiro Shimada, Mutsuhito Matsuda, Masashi Yahagi, Yusuke Yoshikawa, Yusuke Asada, Kiyoaki Sugiura, Yoshiyuki Suzuki, Yuki Tajima, Junpei Nakadai, Yuko Kitagawa. Ataxia telangiectasia mutated relates to epithelial-mesenchymal transition in colorectal cancer. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 5193. doi:10.1158/1538-7445.AM2015-5193

Introduction Right-sided colon cancers (RCC) and left-sided colon cancers (LCC) are of different embryological origins, and there are various differences between them. However, the survival difference has not been evaluated. The aim of the present study was to quantify the difference of prognosis between RCC and LCC by meta-analysis. Method PubMed and the Cochrane Library were searched during May 2014 for literature on right- versus left-sided colon cancers. The MeSH terms “colonic neoplasm” and the terms “prognosis” or “survival analysis” were combined with terms “left” and “right” or “sub site”. The effects of tumour locations on survival outcome (overall survival [OS] and cancer-specific survival [CSS]) were assessed. Hazard ratio (HR) was used as a surrogate for effect size, and random-effects meta-regression was applied as a method to evaluate the influences of covariates. Heterogeneity and publication bias were assessed. Results 15 studies (108,474 participants) which compared the prognosis of colon cancer according to tumour location were included. With respect to OS, patients with RCC had a significantly worse prognosis (HR = 1.14, 95% confidence interval [CI]: 1.06 –1.22, p 2 = 41.82%) than those with LCC. Though, this tendency was not evident for CSS, which might be because CSS was evaluated by a small number of studies included in this analysis. Subgroup analyses demonstrated significant prognostic differences in Western countries (HR = 1.15, 95% CI: 1.08 – 1.23, p Conclusion Our findings indicate that tumour location is closely associated with prognosis in colorectal cancer patients, and those with RCC have a significantly worse prognosis than those with LCC in regards to OS. Therefore, RCC should be treated distinctively from LCC, and the establishment of standardised management for colon cancer by tumour location is needed. Disclosure of interest None Declared.

Introduction Laparoscopic transverse colectomy (LTC) is one of the most challenging techniques because the region of its mesentery and lymph node (LN) dissection is controversial. In addition, anatomical anomalies are often observed in the root of middle colic artery (MCA), which is surrounded by critical vessels such as superior mesenteric vein (SMV), splenic vein (SPV) and inferior mesenteric vein (IMV). We believe that cranial to caudal approach is one of the answers against how to overcome the hurdle of CME and LN dissection in LTC because it’s relatively easy to discern the border of transverse colon mesentery from pancreas. Another is to clarify the dominantly feeding vessel and establish the interest region of lymphandectomy by using CT colonography and angiography preoperatively. Method First, we open the bursa omentalis widely through the gastrocolic ligament, and subsequently mobilise and take down the hepatic and splenic flexure. The anterior lobe of transverse mesocolon is then dissected at the inferior border of the pancreas with the so-called cranial to caudal approach. Right gastroepiploic vein (RGEV) is a landmark to reach SMV. Exposing pancreatic head and second potion of duodenum and blunt dissection are also important to take down hepatic flexure of transverse colon and detach mesentery of transverse colon. In the process, we transect one or two accessory right colonic vein (ARCV). With skeletonizing SMV to proximal side, merging of SMV, SPV and IMV are uncovered. We think it’s critical to harvest the lymph nodes completely in the region enclosed by SMV, SPV and IMV where there should be generally the root of MCA. CT angiography is a robust support to comprehensively recognise the vessel anatomical anomalies and dissected region of colon mesentery. Continuously, it’s possible to dissect the root of ileocolic and right colic vessels with skeletonizing ventral surface of SMA and SMV in this approach. Results We herein present our practical laparoscopic transverse colectomy with LN dissection in video as attatched to demonstrate our concept and strategy in this field. Conclusion We think that cranial to caudal approach is a feasible technique for complete mesocolic excision in laparoscopic transverse colectomy. Disclosure of interest None Declared.

529 Background: Non-alcoholic steatohepatitis (NASH) is closely associated with hepatic fibrosis (HF). The number of patients who have NASH is increasing by eating high-calorie diet. It remains unclear how much impact such NASH and HF on the development of liver metastasis by colorectal cancer (CRC). The objectives of this study is to clarify the influence of HF on metachronous liver-specific recurrence in colorectal cancer patients who underwent colorectal surgery with curative intent. Methods: Between 2000 and 2010, patients who underwent a curative surgical resection for CRC were included in this study. We evaluated the progression of HF by using non-alcoholic fatty liver disease fibrosis score (NFS) based on preoperative blood test result, age, BMI and DM. The patients with NFS higher than 0.676 were objectively defined as HF. The influence of HF on hepatic recurrence was assessed by survival analyses. Results: A total of 953 CRC patients were enrolled, comprised of 293 in stage I, 327 in stage II and 333 in stage III. The mean of NFS was 1.32±1.55, where the included patients were categorized into 77 HF and 876 non-HF. 5-year liver-specific disease-free survival rate in HF was significantly poorer than non-HF (HS 87.0% vs. non-HF 94.5%, log-rank p=0.009). Multivariate analysis demonstrated that HF significantly promoted liver-specific recurrence compared to non-HF (HR=2.16, 95% CI, 1.00 to 4.64; p=0.049). Conclusions: Hepatic fibrosis had a great impact on hepatic recurrence after curative surgical resection of CRCs. These findings indicated that HF might be a favorable microenvironment in developing colorectal liver metastasis. The evaluation of the degree of HF can be useful in selection of adjuvant chemotherapy and postoperative surveillance.

558 Background: Muscle volume loss (MVL) is observed in end-stage cancer patients as cachexia. However, the impact of MVL on tumor response and survival still remains unclear during chemotherapy in metastatic colorectal cancer (mCRC) patients. The aim of this study is to evaluate correlation between MVL and oncologic outcomes in mCRC patients. Methods: A total of 91 mCRC patients who received first-line chemotherapy were identified in our prospective registry between February 2007 and April 2013. Skeletal muscle index at the level of L3 vertebra (SMI) was calculated by muscle volume normalized by stature at the time of the induction of first-line chemotherapy (bSMI) and first evaluation of tumor response (fSMI). Patients whose SMI decreased more than 10% were classified as MVL group. The impact of these variables on oncologic outcomes (overall survival [OS], progression free survival [PFS], and tumor response rate [RR]) were analyzed. Results: Mean bSMI and fSMI were 35.0 (SD: 7.11) cm2/m2, and 34.2 (SD: 6.85) cm2/ m2, respectively. Eighteen patients were classified into the MVL group. The patients in MVL group significantly responded to the chemotherapy (RR of MVL: 11.1% vs. RR of non-MVL: 49.3%, p < 0.01). There was no significant difference in terms of high grade adverse effect between MVL and non-MVL group. Patients in MVL group had a significant shorter median PFS (MVL: 5.5 [2.5 - 10.1] months vs. non-MVL: 12.8 (3.8-80.5) months, p < 0.01) and median OS (MVL: 13.9 [6.2-61.2] months vs. non-MVL: 29.3 (8.2-94.0) months, p < 0.01). Multivariate analysis demonstrated that patients with MVL had significantly worse prognostic factor (OS: HR 3.51 [1.99-6.21], p < 0.01 and PFS: HR 8.27 [2.91-23.5], p < 0.01. Conclusions: The findings of this study suggested that MVL after the induction of the first line chemotherapy could be a novel predictive factor for chemotherapy response and prognosis. Further investigation should be required to clarify the mechanistic background.

556 Background: Liver dysfunction is one of the irritating adverse effects in chemotherapy for colorectal cancer. Polymorphisms of UGTIA1, which is related to metabolism of CPT-11 in the liver, cause severe adverse events. In addition, long-term induction of CPT-11 may involve steatohepatitis. Thus, it is critical to surrogate liver dysfunction in chemotherapy including CPT-11. In this current study, we evaluated whether NAHLD fibrosis score (NFS) which is liver fibrosis marker of nonalcoholic steatohepatitis, is feasible for predicting the effects and adverse events of chemotherapy including CPT-11 for colorectal cancer. Methods: From January 2007 to May 2013, of 118 patients who were diagnosed with unresectable advanced/recurrent colorectal cancer in our hospital, we retrospectively analyzed 89 patients who underwent first line chemotherapy including CPT-11. We statistically analyzed the value of the pretreatment NFS on response rate (RR), progression-free survival (PFS), and hematologic or non-hematologic toxicity of chemotherapy including CPT-11. Results: The median NFS was -1.302 (range=-5.158 to 2.62). Multivariate analysis revealed that NFS was an independent negative predictive marker for RR (coef -0.373 (-0.712 to -0.035), p = 0.031), although no contribution of NFS was observed to PFS (coef 0.958(0.786|1.168), p=0.672). In terms of the adverse events, high value of NFS is an independent risk factor in hematological toxicity (coef 0.93 (0.20 to 1.65), p = 0.012), while not in non-hematological toxicity (coef 0.198 (-0.218|0.613), p=0.351). Conclusions: The pretreatment NFS might be a feasible for predicting response and hematological toxicity in first line chemotherapy including CPT-11 against colorectal cancer.

610 Background: In colorectal cancer (CRC), liver metastasis is one of the critical prognostic factors. However, its pathogenesis still remains unclear. “Stream line theory” is known to be in the liver, where the bloodstream from superior and inferior mesenteric vein make a laminar flow in portal vein, and pour into the right and left hepatic vein, respectively. Recently we have elucidated that stream line theory might affect the pattern of liver metastasis in CRC. We anticipated that the way how to administrate anticancer drug also influence on the effectiveness for liver metastasis in CRC, namely oral administrated drug is absorbed in small intestine and delivered to the right lobe in the liver mainly. We hypothesized that oral intake of anticancer drug suppressed especially recurrence in the right hepatic lobe. The aim of this study is to elucidate the specific pattern of recurrence after curative resection of CRC depending on the way to administrate anticancer drug as adjuvant chemotherapy (AC). Methods: Between January 2003 and September 2013, of 365 patients who were received AC following R0 excision of primary CRC in our institution, we analyzed 94 patients who were diagnosed recurrence. They were divided into 2 groups: 64 patients were received only oral anticancer drug as AC following curative resection of CRC (PO group), and the others are distributed into IV group. A comparative review of clinicohistopathological factors and recurrence pattern were statistically performed. Results: Preoperative CEA levels were significantly higher in IV group than PO group (3.3 vs. 7.6, p=0.03). No other difference was observed in background factor of 2 groups. Comparing the recurrence pattern, 11 (17.2%) were diagnosed recurrence in the right hepatic lobe in PO group while 11 (36.7%) in IV group. There was significantly lower incidence of recurrence in the right hepatic lobe in PO group comparing with IV group (HR=2.79, 95% CI=0.92 to 8.37; p=0.04). Conclusions: AC by oral anticancer drug might specifically suppressed recurrence in the right hepatic lobe behind “stream line theory” in which oral anticancer drug is absorbed in small intestine and mainly drained into the right hepatic lobe.

A 2700 h life test of a single proton exchange membrane fuel cell (PEMFC) with Nafion 112 membrane under nonsaturated humidification was conducted. In situ measurements of hydrogen crossover rate through the membrane and electrochemical active surface area (EAS) of Pt catalyst, in combination with cell polarization curves, were applied to investigate the degradation mechanism. A slow decrease of the EAS of Pt catalyst from 400 to 1900 h running was found to cause a slight voltage decay only at high current densities. However, a subsequent dramatic degradation of the membrane results in an accelerated collapse of the fuel cell.

To improve the ease of production and reproducibility, a novel approach was developed for preparing gas-diffusion layers (GDL) of proton-exchange membrane fuel cells (PEMFCs). In this approach, the GDL was prepared by drydeposition of a mixture of carbon black and polytetrafluoroethylene powders onto water-proofed carbon paper in combination with a subsequent rolling process. Three kinds of carbon black, including Ketjenblack EC-600JD, Vulcan XC-72, and Denka, were investigated. Furthermore, the reproducibility of the GDL with Vulcan XC-72 was also tested. The results indicate that this dry-deposition technique is feasible for mass production applications with simple operation, solvent-free coating and excellent repeatability.