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Supplemental Figure 1. (A) ALT-positive PanNET patients with lymph node metastasis (median survival, 131 months) had a tendency of better survival than ALT-negative PanNET patients with nodal metastasis (54 months, HR=0.31, 95% CI=0.08-1.19; p=0.088). (B) ALT-positive PanNET patients with distant metastasis (overall 5-year survival rate, 75.0%) trended toward better survival than ALT-negative patients (25.0%), but was not statistically significant (p=0.118).

Purpose: Alternative lengthening of telomeres (ALT), a telomerase-independent telomere maintenance mechanism, is strongly associated with ATRX and DAXX alterations and occurs frequently in pancreatic neuroendocrine tumors (PanNET).Experimental Design: In a Korean cohort of 269 surgically resected primary PanNETs and 19 sporadic microadenomas, ALT status and nuclear ATRX and DAXX protein expression were assessed and compared with clinicopathologic factors.Results: In PanNETs, ALT or loss of ATRX/DAXX nuclear expression was observed in 20.8% and 19.3%, respectively, whereas microadenomas were not altered. ALT-positive PanNETs displayed a significantly higher grade, size, and pT classification (all, P < 0.001). ALT also strongly correlated with lymphovascular (P < 0.001) and perineural invasion (P = 0.001) and the presence of lymph node (P < 0.001) and distant metastases (P = 0.002). Furthermore, patients with ALT-positive primary PanNETs had a shorter recurrence-free survival [HR = 3.38; 95% confidence interval (CI), 1.83–6.27; P < 0.001]. Interestingly, when limiting to patients with distant metastases, those with ALT-positive primary tumors had significantly better overall survival (HR = 0.23; 95% CI, 0.08–0.68; P = 0.008). Similarly, tumors with loss of ATRX/DAXX expression were significantly associated with ALT (P < 0.001), aggressive clinical behavior, and reduced recurrence-free survival (P < 0.001). However, similar to ALT, when limiting to patients with distant metastases, loss of ATRX/DAXX expression was associated with better overall survival (P = 0.003).Conclusions: Both primary ALT-positive and ATRX/DAXX-negative PanNETs are independently associated with aggressive clinicopathologic behavior and displayed reduced recurrence-free survival. In contrast, ALT activation and loss of ATRX/DAXX are both associated with better overall survival in patients with metastases. Therefore, these biomarkers may be used as prognostic markers depending on the context of the disease. Clin Cancer Res; 23(6); 1598–606. ©2016 AACR.

Correlation between ALT status and ATRX and DAXX protein expression.

(A) ALT-positive PanNET patients with lymph node metastasis (median survival, 131 months) had a tendency of better survival than ALT-negative PanNET patients with nodal metastasis (54 months, HR=0.31, 95% CI=0.08-1.19; p=0.088). (B) ALT-positive PanNET patients with distant metastasis (overall 5-year survival rate, 75.0%) trended toward better survival than ALT-negative patients (25.0%), but was not statistically significant (p=0.118).

The diagnosis of type 2 autoimmune pancreatitis (AIP) is dependent on typical radiologic imaging and the presence of the granulocytic epithelial lesion (GEL), which is characterized by ductal neutrophilic infiltration with or without neutrophilic acinar infiltration.We evaluated GEL and related clinicopathologic factors in 165 resected heterotopic pancreata (HPs) [57 gastric (35%), 56 duodenal (34%), 30 omental (18%), and 22 jejunal (13%)] and 29 matched orthotopic pancreata routinely examined during surgery.GEL was noted in 8% (13/165) of HPs, including ductal epithelial (6/13, 46%) and intraluminal (8/13, 62%) neutrophilic infiltrations. However, there was no GEL in orthotopic pancreata. Abdominal pain was observed in 6 (46%) patients with GEL-positive HPs. GEL was more commonly observed in HPs having symptoms (p = 0.029), a larger size (p = 0.028), and an infiltrative growth pattern (p = 0.006). In addition, periductal lymphoplasmacytic infiltration and fibrosis (both p 0.001), interstitial fibrosis (p = 0.017), acinar neutrophilic infiltration (p = 0.032), venulitis (p = 0.050), acinar ductal metaplasia (ADM; p = 0.040), and pancreatic intraepithelial neoplasia/intraductal papillary mucinous neoplasms (PanIN/IPMN; p 0.001) were more commonly seen in HPs with GEL than in those without GEL. Inflammatory bowel disease was present only in one patient with GEL-negative HP.GELs are detected in a subset of HPs without clinical evidence of AIP. Therefore, for the diagnosis of AIP, GEL should be carefully interpreted with the context of other histologic, clinical, and radiologic findings.

Lattice oxygen redox offers an unexplored way to access superior electrochemical properties of transition metal oxides (TMOs) for rechargeable batteries. However, the reaction is often accompanied by unfavourable structural transformations and persistent electrochemical degradation, thereby precluding the practical application of this strategy. Here we explore the close interplay between the local structural change and oxygen electrochemistry during short- and long-term battery operation for layered TMOs. The substantially distinct evolution of the oxygen-redox activity and reversibility are demonstrated to stem from the different cation-migration mechanisms during the dynamic de/intercalation process. We show that the π stabilization on the oxygen oxidation initially aids in the reversibility of the oxygen redox and is predominant in the absence of cation migrations; however, the π-interacting oxygen is gradually replaced by σ-interacting oxygen that triggers the formation of O-O dimers and structural destabilization as cycling progresses. More importantly, it is revealed that the distinct cation-migration paths available in the layered TMOs govern the conversion kinetics from π to σ interactions. These findings constitute a step forward in unravelling the correlation between the local structural evolution and the reversibility of oxygen electrochemistry and provide guidance for further development of oxygen-redox layered electrode materials.

Solid pseudopapillary neoplasms (SPNs) of the pancreas have low malignant potential. However, malignant SPNs are not fully understood.To evaluate risk factors affecting malignant potential, the clinicopathologic features of 375 surgically resected SPNs were compared.Fifty (13.3%) had malignant histologic features. Twenty-seven and 22 had perineural and lymphovascular invasions, respectively. Adjacent organ invasion was noted in 9 cases. Recurrence occurred in 8 cases. The median recurrence time after surgical resection was 67 months and was associated with a higher pT category (P = 0.001), lymphovascular invasion (P 0.001), and synchronous metastasis (P 0.001). SPN patients with malignant histologic features had worse recurrence-free survival (RFS; 10-year survival rate, 73.2%) than those without malignant histologic features (96.3%; P = 0.01). Patients with a higher pT category (P = 0.04), synchronous metastasis (P 0.01), and lymphovascular invasion (P 0.01) had worse RFS. Lymphovascular invasion (P = 0.042) and a higher T category (P = 0.002) were poor prognostic factors for recurrence.Lymphovascular invasion and a higher T category were worse prognostic factors for recurrence in SPN patients with malignant histologic features. For SPN patients with malignant histologic features, a longer follow-up may be required.

We have reported that autophagy is crucial for clearance of amyloidogenic human IAPP (hIAPP) oligomer, suggesting that an autophagy enhancer could be a therapeutic modality against human diabetes with amyloid accumulation. Here, we show that a recently identified autophagy enhancer (MSL-7) reduces hIAPP oligomer accumulation in human induced pluripotent stem cell-derived β-cells (hiPSC-β-cells) and diminishes oligomer-mediated apoptosis of β-cells. Protective effects of MSL-7 against hIAPP oligomer accumulation and hIAPP oligomer-mediated β-cell death are significantly reduced in cells with knockout of MiTF/TFE family members such as Tfeb or Tfe3. MSL-7 improves glucose tolerance and β-cell function of hIAPP+ mice on high-fat diet, accompanied by reduced hIAPP oligomer/amyloid accumulation and β-cell apoptosis. Protective effects of MSL-7 against hIAPP oligomer-mediated β-cell death and the development of diabetes are also significantly reduced by β-cell-specific knockout of Tfeb. These results suggest that an autophagy enhancer could have therapeutic potential against human diabetes characterized by islet amyloid accumulation., Islet amyloid polypeptide (IAPP) deposition is associated with islet cell loss in diabetes. Here the authors show that a small molecule autophagy enhancer reduces IAPP accumulation in vitro, and also improves glucose tolerance in hIAPP+ mice fed high-fat diet, accompanied by reduced hIAPP accumulation, in vivo.

Human embryonic stem cells (hESCs) hold promise in regenerative medicine but allogeneic immune rejections caused by highly polymorphic human leukocyte antigens (HLAs) remain a barrier to their clinical applications. Here, we used a CRISPR/Cas9-mediated HLA-editing strategy to generate a variety of HLA homozygous-like hESC lines from pre-established hESC lines. We edited four pre-established HLA-heterozygous hESC lines and created a mini library of 14 HLA-edited hESC lines in which single HLA-A and HLA-B alleles and both HLA-DR alleles are disrupted. The HLA-edited hESC derivatives elicited both low T cell- and low NK cell-mediated immune responses. Our library would cover about 40% of the Asian-Pacific population. We estimate that HLA-editing of only 19 pre-established hESC lines would give rise to 46 different hESC lines to cover 90% of the Asian-Pacific population. This study offers an opportunity to generate an off-the-shelf HLA-compatible hESC bank, available for immune-compatible cell transplantation, without embryo destruction. Graphical Abstract Supplementary Information The online version contains supplementary material available at 10.1007/s12015-020-10113-7.

The development of high-tap density electrode materials that can simultaneously achieve stable electrochemical performance at high charge/discharge rates is critically in demand. Herein, we propose an innovative material design that can offer high tap density and excellent rate capabilities by using Co3O4 nanograin-interconnected secondary particles (Co3O4 NISPs). By taking advantage of a conversion reaction that forms Co from Co3O4, we demonstrate that Co3O4 NISPs are capable of creating a number of metallic Co sites along with a number of vacant sites in-between nanograins. Electrochemical tests that reveal reduced internal cell resistance and more accessible Li diffusion are achieved for Co3O4 NISPs compared with Co3O4 nanoparticles (NPs). Additionally, in situ X-ray diffraction (XRD) analyses, electron energy loss spectroscopy (EELS), and density functional theory (DFT) calculations reveal that the insulating intermediate product (CoO) is formed less on the Co3O4 NISPs, which can enhance the charge transport. Attributed to the combinatorial effects of Co3O4 nanograins that form metallic Co upon conversion and secondary particles that enable high tap density, Co3O4 NISPs show the most outstanding volumetric capacity (2167.3 mA h cm−3 at a current density of 500 mA g−1) among spinel-type metal oxide electrode materials researched so far.

Large duct pattern of pancreatic ductal adenocarcinomas (PDACs) comprises occasional large cancer glands (0.5 mm in size), along with conventional smaller cancer glands. They histologically mimic intraductal papillary mucinous neoplasms. However, the clinicopathologic significance of PDACs with predominant large duct pattern (PLDP) has not been systematically evaluated. A total of 41 cases of PDACs with PLDP, which were defined as irregularly-shaped cancer glands0.5 mm in size occupied50% of tumor volume, were enrolled and their clinicopathological, immunohistochemical, and targeted exome-wise mutational characteristics were compared with 298 conventional PDACs. PDACs with PLDP had cancers with larger tumor sizes (P = 0.025), which were more frequently well to moderately differentiation (P 0.001), with less lymphovascular invasion (P = 0.013) and had a higher T category (P = 0.023) than conventional PDACs. Immunohistochemically, PDACs with PLDP showed similar abnormal p53 (61%) and SMAD4 (59%) expression patterns as conventional PDACs. In addition, PDACs with PLDP showed diffuse MUC1 (88%), MUC5AC (100%), MUC6 (66%), and focal MUC2 (20%) expressions. More frequent ROS1 mutations were observed in PDACs with PLDP. PDAC patients with PLDP had a better overall and recurrence-free survival (OS and RFS; median, 42 and 34 months) than that of patients with conventional PDACs (34 and 16 months) as per univariate (P = 0.037 and P = 0.001) and multivariate (P = 0.031 and P = 0.034) analyses. PDACs with PLDP showed mutational patterns similar to those of conventional PDACs. They had unique histologic features and longer OS and RFS compared to those of conventional PDACs. Therefore, PDACs with PLDP could be considered a histologic subtype of PDACs.

Venous invasion is a poor prognostic factor for pancreatic ductal adenocarcinoma (PDAC). However, our understanding of various features of venous invasion is limited. Our aim is to comprehensively evaluate various histopathologic features of venous invasion, including status, type (lymphatic or venous), number of invasion foci, and histologic pattern (pancreatic intraepithelial neoplasia [PanIN]-like, conventional) in PDACs.Various features of venous invasion, including status, number of invasion foci, histologic patterns [pancreatic intraepithelial neoplasia (PanIN)-like, conventional], and size of involved vessels in 471 surgically resected PDACs were evaluated with all available hematoxylin and eosin (HE)-stained slides.Venous invasion was observed in 319 cases (67.7%) and was more frequently associated with increased tumor size, extrapancreatic extension, resection margin involvement, diffuse tumor distribution, lymph node metastasis, and perineural invasion (all Ps .05). High frequency (≥3 foci) of venous invasion was associated with shorter overall survival both in the entire group and in the early stage subgroup (stage I; all Ps .05). Multivariate analysis indicated that a high frequency (≥3 foci) of venous invasion, large tumor size (4 cm), higher histologic grade, and lymph node metastasis, were independent prognostic factors of worse overall survival (all Ps .05).Precise evaluation of venous invasion status, including foci number of invasion, can provide additional prognostic information for patients undergoing surgical resection of PDAC, especially for those with early disease stage.

Background Non-HLA antibodies, anti-angiotensin II type 1 receptor antibodies (anti-AT1R) and anti-endothelial cell antibodies (AECA), are known to play a role in allograft rejection. We evaluated the role of both antibodies in predicting post-transplant outcomes in low-risk living donor kidney transplantation (LDKT) recipients. Methods In 94 consecutive LDKT recipients who were ABO compatible and negative for pre-transplant HLA donor-specific antibodies, we determined the levels of anti-AT1Rs using an enzyme-linked immunosorbent assay and the presence of AECAs using a flow cytometric endothelial cell crossmatch (ECXM) assay with pre-transplant sera. Hazard ratio (HR) was calculated to predict post-transplant outcomes. Results Pre-transplant anti-AT1Rs (≥11.5 U/mL) and AECAs were observed in 36 (38.3%) and 22 recipients (23.4%), respectively; 11 recipients had both. Pre-transplant anti-AT1Rs were a significant risk factor for the development of acute rejection (AR) (HR 2.09; P=0.018), while a positive AECA status was associated with AR or microvascular inflammation only (HR 2.47; P=0.004) throughout the follow-up period. In particular, AECA (+) recipients with ≥11.5 U/mL anti-AT1Rs exhibited a significant effect on creatinine and estimated glomerular filtration rate (P

Background BK virus (BKV)–associated nephropathy is a significant complication of kidney transplantation that progresses to graft dysfunction and graft loss. The aim of this study was to know the infection rate and progression of BKV according to our strategy. Materials and Methods This study included 302 patients who received kidney transplantation between August 2010 and October 2012. Patients were divided into 4 groups: no BK infection, BK viruria only, low BK viremia, and high BK viremia. Results In this study, 57 patients had BK viremia (18.9%), and 18 patients had BK nephropathy (5.9%) during a 2-year follow-up period. Age, sex, cytomegalovirus (CMV) viremia, existence of donor-specific antibodies, type of transplantation, and delayed graft function were not significantly different. Disappearance of BKV infection was better in the viruria and low viremia groups than in the high viremia group (P = .001), and duration of BK infection was longer in the high viremia group than the low viremia group (P = .002). Conclusion All diagnosed cases of BKV nephropathy were in the high BK viremia group. For BK viruria and viremia, early detection of BK infection together with early intervention by reduced immunosuppressant is a useful strategy to maintain allograft function. Long-term follow up is required to identify the risk factors for BK infection and graft survival after kidney transplantation.

Summary: Background: Many immunosuppressive drugs are prescribed as twice-daily dosing. A simplified once-daily dosing of immunosuppressive drug regimen may improve medication adherence. We investigated medication adherence of simplified once-daily immunosuppressive regimen consisting of extended-release tacrolimus, sirolimus, and corticosteroids along with the efficacy and safety of this regimen. Methods: This study was a prospective, multicenter, controlled and cohort trial. Stable kidney transplant recipients who had received transplantation at least 3 months before the study enrollment were eligible for the study. Participants were required to fill-out the self-reported immunosuppressant therapy barrier scale (ITBS) questionnaire before and after the conversion. Other clinical laboratory parameters and adverse events were evaluated until 6 months post-conversion. Results: A total of 160 kidney recipients comprised the intention-to-treat population. The mean total ITBS score was 19.5 ± 4.0 at pre-conversion and 6 months after converting, the mean total ITBS score was 16.6 ± 3.6 (p

The efficacy of an immune checkpoint blockade has been demonstrated against various types of cancer, but its suitability has not been fully proven for therapies specifically targeting sarcoma. We conducted a pan-cancer tumor data analysis to identify key immune-related variables strongly associated with sarcoma prognosis, and we explored whether these expected factors are functionally correlated with anti-PD-1 therapy in humanized (Hu) NOD.Cg-PrkdcscidIl2rgtm1Wjl/SzJ (NSG) mice xenografted with dedifferentiated liposarcoma (DDLPS). We found that an abundance of hCD8+ T cells and hNK cells was functionally associated with anti-PD-1 effects in the Hu-NSG DDLPS mice. Phenotypically, these cells were shown to be hCD8+IFNγ+, hCD8+PD-1+, hCD8+Ki-67+, hCD56+IFNγ+, hCD56+PD-1+, and hCD56+Ki-67+ cells and were enriched in splenocytes and tumor-infiltrating lymphocytes (TILs) of Hu-NSG DDLPS mice treated with anti-PD-1 antibody. Moreover, a considerable increase in activated hCD56+NKp46+NKG2D+ NK cells was also detected. Our findings suggest that hCD8+ T and hNK subsets play a pivotal role in anti-DDLPS tumor effects of anti-PD-1 therapy. The results provide clinical reference for advanced anti-PD-1 therapy targeting sarcoma tumors including DDLPS.

The New Zealand public sector reform process of the late 1980s and early 1990s was notable for its attempt to clarify public accountability through the specification of outputs, contractual agreements and the disaggregation of government departments into smaller, more sharply focused agencies. While the reforms achieved managerial improvements, the accountability regime was less successful because of the difficulties of specification and the continuing robustness of ministerial responsibility in the face of attempts to limit the political control and accountability. INTRODUCTION: REASSESSING THE NEW ZEALAND MODEL New Zealand holds a special place in the recent history of public sector reform. In three major pieces of legislation in the 1980s (the State-Owned Enterprises Act 1986, the State Sector Act 1988 and the Public Finance Act 1989) it implemented a particularly radical version of what became known as the 'new public management' (NPM) and indeed provided an archetype of that movement (Hood 1991). The fact that reform was premised on a coherent theoretical blueprint (Treasury, 1987), which was then followed through with remarkable thoroughness and consistency marked New Zealand out as especially interesting to academic analysts as well as to practitioners with a taste for rational principle rather than incremental pragmatism. The degree of principled consistency was always somewhat overstated (Boston et al., 1996:84-85), and the system was subject to constant adjustment after its initial enactment. None the less, it stands out as a heroic, and ultimately (and predictably) unsuccessful, attempt to ground public management on clear assumptions and unambiguous principles. Clarity was the watchword of the reforms. The root causes of government inefficiency and ineffectiveness were perceived to be the failure to specify the objectives of government agencies and confusion over roles (between politicians and public servants and within public agencies) (Treasury, 1987; Scott, 1996). Once each agency and each key actor had their role clarified and their objectives specified, they could be freed from debilitating controls over inputs and processes. They could also be more readily held accountable for their performance in terms of clearly specified roles and objectives. From these assumptions followed most of the key elements of the new system (Boston et al., 1996; Treasury, 1996), including the separation of the roles of ministers and departmental chief executives (CEs), with ministers responsible for choosing 'outcomes' and CEs responsible for delivering 'outputs'; the emphasis on clear specification and costing of departmental outputs; the separation between the government's interest as 'purchaser' of public services and its interest as 'owner' of government agencies (and the consequent distinction between 'vote' ministers and 'responsible' ministers); the decoupling of non-departmental agencies ('crown entities' and 'state owned-enterprises') from ministerial direction; the disaggregation of large multi-function departments into more narrowly focused policy ministries, service delivery agencies and independent monitoring agencies; the reliance on explicit contract-like agreements to spell out the government's expectations from individual CEs and agencies. The New Zealand system has been subject to extensive examination (Scott 2001:42-62), including two major government-sponsored reviews (Logan 1991; Schick 1996) as well as several thorough academic assessments (Boston et al., 1996). In terms of improved efficiency and effectiveness, considerable benefits have been found to flow from the relaxation of central agency controls over inputs, the reorientation of agencies towards results and the adoption of strategic planning. Savings have been achieved through the decoupling of public service provision from core government departments, for instance through outsourcing, corporatization and privatization. …

Redox mediators (RMs) are considered an effective countermeasure to reduce the large polarization in lithium–oxygen batteries. Nevertheless, achieving sufficient enhancement of the cyclability is limited by the trade–offs of freely mobile RMs, which are beneficial for charge transport but also trigger the shuttling phenomenon. Here, we successfully decoupled the charge–carrying redox property of RMs and shuttling phenomenon by anchoring the RMs in polymer form, where physical RM migration was replaced by charge transfer along polymer chains. Using a model system of a polymer, PTMA (2,2,6,6–tetramethyl–1–piperidinyloxy–4–yl methacrylate), based on the well–known RM tetramethylpiperidinyloxyl (TEMPO), it is demonstrated that PTMA is capable of functioning as a stationary RM, preserving the redox activity of TEMPO. The efficiency of RM–mediated Li2O2 decomposition remains remarkably stable without the consumption of oxidized RMs or degradation of the lithium anode, resulting in marked improvement of the performance of the lithium–oxygen cell.

Sodium vanadate (Na1+xV3O8 or NVO) has recently attracted significant interest as a potential cathode material for an aqueous Zn ion battery for its unique pillared framework facilitating Zn ion migration. Here, we performed a detailed study on reaction mechanisms of hydrated Na2V6O16·2H2O slabs and nonhydrated Na1.25V3O8 nanorods using transmission electron microscopy. Our initial observation reveals that the thin (30–50 nm) Na2V6O16·2H2O system successfully undergoes discharge with Zn ion insertion into the structure while thick (120–170 nm) Na1.25V3O8 allows Zn ion insertion only at the surface, signifying the importance of both the presence of water and the nanostructure thickness in determining the reaction mechanism of NVO. More in-depth analysis of these two systems revealed the irreversible formation of the stable byproduct phase Zn3Nax(OH2)V2O7 (ZNVO), which likely evolved through a Zn-ion redox reaction, contributing to overall cell performance. Eventually, the entire discharge/charge process ap...

Despite the high energy density of lithium-rich layered-oxide electrodes, their real-world implementation in batteries is hindered by the substantial voltage decay on cycling. This voltage decay is widely accepted to mainly originate from progressive structural rearrangements involving irreversible transition-metal migration. As prevention of this spontaneous cation migration has proven difficult, a paradigm shift toward management of its reversibility is needed. Herein, we demonstrate that the reversibility of the cation migration of lithium-rich nickel manganese oxides can be remarkably improved by altering the oxygen stacking sequences in the layered structure and thereby dramatically reducing the voltage decay. The preeminent intra-cycle reversibility of the cation migration is experimentally visualized, and first-principles calculations reveal that an O2-type structure restricts the movements of transition metals within the Li layer, which effectively streamlines the returning migration path of the transition metals. Furthermore, we propose that the enhanced reversibility mitigates the asymmetry of the anionic redox in conventional lithium-rich electrodes, promoting the high-potential anionic reduction, thereby reducing the subsequent voltage hysteresis. Our findings demonstrate that regulating the reversibility of the cation migration is a practical strategy to reduce voltage decay and hysteresis in lithium-rich layered materials.