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Abbreviations & Acronyms AE = adverse event BC = bladder cancer CI = confidence interval CTCAE v4.0 = Common Terminology Criteria for Adverse Events version 4.0 GC = gemcitabine and cisplatin GCarbo = gemcitabine and carboplatin GEM = gemcitabine HR = hazard ratio ICI = immune checkpoint inhibitor IQR = interquartile range LN = lymph node MEC = methotrexate, epirubicin and cisplatin MVAC = methotrexate, vinblastine, doxorubicin and cisplatin ORR = objective response rate OS = overall survival PFS = progression-free survival PG = paclitaxel and gemcitabine PS = performance status PTX = paclitaxel UC = urothelial carcinoma UTUC = upper urinary tract urothelial carcinoma UUT = upper urinary tract

Abstract. The present study aimed to examine the association between 18 F-fluorodeoxyglucose ( 18 F-FDG) uptake and cell proliferation markers; in addition, the correlation between 18 F-FDG uptake and biological characteristic in patients with renal cell carcinoma (RCC) was investigated using dual-phase 18 F-FDG-positron emission tomography/computed tomography (PET/CT). Dual-phase 18 F-FDG PET/CT was performed on 31 RCC patients and the maximum standardized uptake values at 1 h (SUV1) and 2 h (SUV2) as well as the retention index (RI; %) in the primary tumors were calculated. Monoclonal antibodies for Ki-67, minichromosome maintenance 2 (MCM2) and topoisomerase II α (topo II α) were used to assess the expression levels of their respective proteins in excised tumor tissue using immunohistochemistry. The results demonstrated that RI and SUV2 in patients with Stage I/II + grade 1 (G1) RCC were significantly decreased compared with all patients with other stages/grades (RI, P= 0.0065; SUV2, P= 0.043); in addition, significantly increased uptake and RI were detected in patients with metastases compared with patients without metastases (SUV1, P= 0.029; SUV2, P= 0.0003; RI, P<0.001). All proliferation markers significantly correlated with RI (Ki-67, r= 0.501, P= 0.004; MCM2, r= 0.359, P= 0.047; topo II α, r= 0.402, P= 0.024), while SUV1 and SUV2 correlated with Ki-67 only. In conclusion, the results of the present study demonstrated that dual-phase 18 F-FDG-PET/CT was more useful for predicting cell proliferation in RCC compared with single-phase imaging alone.However, follow-ups are required in order to determine whether dual-phase 18 F-FDG-PET/CT provides independent prognostic information. Introduction F-fluorodeoxyglucose (18 F-FDG)-positron emission tomography (PET) is useful for evaluation of post-surgical recurrence and distant metastasis, therapeutic response to multikinase inhibitor in metastatic renal carcinoma, and prediction of prognosis for advanced renal cell carcinoma (RCC) (1-4). However, the utility of 18 F-FDG-PET for evaluating primary tumors is controversial. As the urinary tract is the major excretion route of 18 F-FDG, high background activity may mask uptake by primary lesions; therefore, the sensitivity, specificity and accuracy for primary RCCs have been variable in previous studies (1,5).Tumor cell proliferation has been reported to correlate with tumor growth and patient prognosis (6). Commonly used immunohistochemical cell proliferation markers include Ki-67 antigen, minichromosome maintenance protein 2 (MCM2) and topoisomerase II α (topo II α) (7-10). The Ki-67 antigen expression is indicative of the proportion of active cells throughout the cell cycle, which makes it an excellent marker for determining the growth fraction of cell populations (7). MCM2 is a superior marker to Ki-67 for assessment of the cell cycle, pathological factors and prognosis in RCC patients (8). Topo II α was reported to be a potential marker of anticancer agent efficacy; in addition, its marked expression in highly...

We report a rare case of ectopic ACTH syndrome associated with undifferentiated carcinoma of the ascending colon. A 62-year-old woman developed hypokalaemia and metabolic alkalosis associated with markedly elevated serum cortisol and plasma ACTH levels. High-dose dexamethasone (8 mg/day) did not suppress increased urinary 17-hydroxycorticosteroid and 17-keto-steroid excretion. Barium enema and abdominal computerised tomography showed a Borrmann II type tumour in the ascending colon, multiple metastatic nodules in the liver and bilateral enlargement of the adrenal glands. Histological examination of the resected primary colon cancer and metastatic liver tumour showed undifferentiated carcinoma with areas of distinct neuroendocrine, exocrine, and squamous differentiation. ACTH production by the tumour was confirmed by radioimmunoassay and immunohistochemistry. This is a unique case report of carcinoma of the colon with distinct multidirectional differentiation causing ectopic ACTH syndrome.

Puerariae flos extract (PFE) has been reported to have many effects, including preventing the development of hangovers, liver protective effects, and an estrogenic effect. In addition, some papers reported that PFE is effective against metabolic diseases, with hypolipidemic and hypoglycemic effects. However, the mechanism underlying such effects remains unclear. For the purpose of clarifying the effect of PFE on metabolic diseases related to the accumulation of visceral fat and to determine the mechanism of such action, TSOD mice, a multifactorial genetic disease animal model that spontaneously develops various metabolic diseases such as obesity and type 2 diabetes, were given a Western diet (WTD) as an environmental factor to prepare a disease model (TSOD-WTD). When TSOD mice were loaded with WTD, it was confirmed that metabolic diseases such as obesity and abnormal glucose/lipid metabolism are aggravated. In contrast, PFE treatment to TSOD-WTD mice was shown to suppress body weight gain and visceral fat accumulation, alleviated the abnormal glucose tolerance and hyperinsulinemia, as well as causing an increase in blood adiponectin. Furthermore, the suppression of liver enlargement was observed in PFE-treated mice, with suppression of fatty degeneration and anti-inflammatory effect. In addition, to clarify the mechanism of the hyperlipidemia-alleviating effects in the liver, we investigated the effect of PFE on the expression of genes involved in cholesterol homeostasis. PFE was associated with a significant increase in gene expression for cholesterol synthesis rate-limiting enzyme HMG-CoA reductase, cholesterol catabolization enzyme Cyp7A1, bile salt export pump adenosine triphosphate-binding cassette transporter B11, and low-density lipoprotein receptor involved in cholesterol uptake. The above results suggest that PFE acts to alleviate the effects of various metabolic diseases based on the accumulation of visceral adipose tissue, including obesity, diabetes, and hyperlipidemia, with the promotion of catabolization/excretion of cholesterol in the liver being a key mechanism of action.