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ABSTRACT Blunt abdominal trauma causing intraperitoneal injury and/or bleeding can be life‐threatening, requiring immediate intervention. Diagnosing these cases can be challenging, especially when pre‐existing conditions are involved. Low‐grade appendiceal mucinous neoplasm (LAMN) is a rare tumor of the appendix that can lead to pseudomyxoma peritonei. Herein, we present a case of ruptured LAMN following blunt abdominal trauma after a high‐energy head‐on collision, complicating the differentiation from other intraperitoneal injuries. A 42‐year‐old Japanese female was brought to our hospital following high‐energy head‐on collision. She presented with stable vital signs, complaining of anterior chest pain and abdominal tenderness without peritoneal irritation. Computed tomography scans indicated multiple fractures in her chest and complex fluid around the Douglas fossa extending to the ileocecal area, with a slightly dilated appendix tip. Despite stable vitals, emergency laparotomy was needed for suspected peritonitis and/or intraperitoneal hemorrhage. Emergency laparotomy revealed yellowish, jelly‐like ascites and a ruptured appendiceal tumor. LAMN was suspected, and the appendix was completely resected, with cytoreductive surgery carefully performed. Histopathological examination confirmed the diagnosis of LAMN. Postoperative course was uneventful, and the patient was discharged on Day 13 and referred for further LAMN management. This case report highlights the diagnostic difficulties of LAMN rupture following blunt abdominal trauma, stressing the need to consider rare conditions like LAMN in differential diagnoses of acute abdomen posttrauma.

Abstract An 83‐year‐old woman with RET fusion‐positive advanced lung adenocarcinoma was administered selpercatinib 320 mg/day. Despite the shrinking of the tumour, fever, fatigue, and anorexia developed on day 17. Selpercatinib administration was interrupted. On day 21, elevated blood aspartate aminotransferase (AST) and alanine aminotransferase (ALT) were observed. On day 28, AST and ALT levels increased to demonstrate Grade 4 in CTCAE Ver.5. The patient received a glycyrrhizin‐compounding agent and steroid treatment, and AST and ALT levels gradually decreased. On day 63, selpercatinib 160 mg/day was restarted after improvement of the hepatic disorder. Since then, selpercatinib was continued without any severe adverse events. Selpercatinib is a reasonable treatment option for RET fusion‐positive advanced non‐small cell lung cancer even in older patients. However, old age may be a risk factor for adverse events including hepatic disorders. For safe treatment in such patients, careful follow‐up is required.

Glioma‐initiating cells (GICs), a major source of glioblastoma recurrence, are characterized by the expression of neural stem cell markers and the ability to grow by forming nonadherent spheres under serum‐free conditions. Bone morphogenetic proteins (BMPs), members of the transforming growth factor‐β family, induce differentiation of GICs and suppress their tumorigenicity. However, the mechanisms underlying the BMP‐induced loss of GIC stemness have not been fully elucidated. Here, we show that paired related homeobox 1 (PRRX1) induced by BMPs decreases the CD133‐positive GIC population and inhibits tumorigenic activity of GICs in vivo. Of the two splice isoforms of PRRX1, the longer isoform, pmx‐1b, but not the shorter isoform, pmx‐1a, induces GIC differentiation. Upon BMP stimulation, pmx‐1b interacts with the DNA methyltransferase DNMT3A and induces promoter methylation of the PROM1 gene encoding CD133. Silencing DNMT3A maintains PROM1 expression and increases the CD133‐positive GIC population. Thus, pmx‐1b promotes loss of stem cell‐like properties of GICs through region‐specific epigenetic regulation of CD133 expression by recruiting DNMT3A, which is associated with decreased tumorigenicity of GICs.

Development of innovative therapeutic modalities would address an unmet clinical need in the treatment of triple negative breast cancer (TNBC). Activation of retinoic acid‐inducible gene‐I (RIG‐I)‐like receptors (RLRs) such as melanoma differentiation‐associated gene 5 (MDA5) and RIG‐I in cancer cells is suggested to suppress tumor progression by inducing cell death. Transfection of polyI:C, a conventionally used synthetic double‐stranded RNA (dsRNA) analogue that activates RLRs, has been evaluated in clinical trials. However, detailed mechanisms of tumor suppression by RLRs, especially interactions with other signaling pathways, remain elusive. Here, we showed that transfection of polyI:C suppressed transforming growth factor‐β (TGF‐β) signaling in a MDA5‐ and RIG‐I‐dependent manner. We found that suppression of TGF‐β signaling by polyI:C promoted cancer cell death, which was attenuated by forced expression of constitutively active Smad3. More detailed analysis suggested that cell death by polyI:C transfection exhibited characteristics of pyroptosis, which is distinct from apoptosis. Therapeutic efficacy of polyI:C transfection was also demonstrated using a mouse model. These results indicated that intratumor administration of polyI:C and related dsRNA analogues may be promising treatments for TNBC through inhibition of the anti‐pyroptotic function of TGF‐β.

Aim. When determining therapeutic strategy, it is important to diagnose small intestinal lesions in Crohn's disease (CD) precisely and to evaluate mucosal healing as well as clinical remission in CD. The purpose of this study was to compare findings from computed tomographic enteroclysis/enterography (CTE) with those from the mucosal surface and to determine whether the state of mucosal healing can be determined by CTE. Materials and Methods. Of the patients who underwent CTE for CD, 39 patients were examined whose mucosal findings could be confirmed by colonoscopy, capsule endoscopy, balloon endoscopy, or with the resected surgical specimens. Results. According to the CTE findings, patients were determined to be in the active CD group (n=31) or inactive CD group (n=8). The proportion of previous surgery, clinical remission, stenosis, and CDAI score all showed significant difference between groups. Mucosal findings showed an association with ulcer in 93.6% of active group patients but in only 12.5% of inactive group patients (P