IgG4-related pancreatobiliary diseases could be associated with onset of pancreatobiliary cancer: A multicenter cohort study

BACKGROUND

The risk and prognosis of pancreatobiliary cancer and in patients with autoimmune pancreatitis (AIP) and IgG4-related sclerosing cholangitis (IgG4-SC) remain unclear. Therefore, we retrospectively investigated the risk of pancreatobiliary cancer and prognosis in patients with AIP and IgG4-SC.

METHODS

Patients with AIP and IgG4-SC at seven centers between 1998 and 2022 were investigated. The following data were evaluated: (1) the number of cancers diagnosed and standardized incidence ratio (SIR) for pancreatobiliary and other cancers during the observational period and (2) prognosis after diagnosis of AIP and IgG4-SC using standardized mortality ratio (SMR).

RESULTS

This study included 201 patients with AIP and IgG4-SC. The mean follow-up period was 5.7 years. Seven cases of pancreatic cancer were diagnosed, and the SIR was 8.11 (95% confidence interval [CI]: 7.29-9.13). Three cases of bile duct cancer were diagnosed, and the SIR was 6.89 (95% CI: 6.20-7.75). The SMR after the diagnosis of AIP and IgG4-SC in cases that developed pancreatobiliary cancer were 4.03 (95% CI: 2.83-6.99).

CONCLUSIONS

Patients with autoimmune pancreatitis and IgG4-SC were associated with a high risk of pancreatic and bile duct cancer. Patients with AIP and IgG4-SC have a worse prognosis when they develop pancreatobiliary cancer.

An extremely energetic cosmic ray observed by a surface detector array

Cosmic rays are energetic charged particles from extraterrestrial sources, with the highest-energy events thought to come from extragalactic sources. Their arrival is infrequent, so detection requires instruments with large collecting areas. In this work, we report the detection of an extremely energetic particle recorded by the surface detector array of the Telescope Array experiment. We calculate the particle's energy as [Formula: see text] (~40 joules). Its arrival direction points back to a void in the large-scale structure of the Universe. Possible explanations include a large deflection by the foreground magnetic field, an unidentified source in the local extragalactic neighborhood, or an incomplete knowledge of particle physics.

IgG4-related sclerosing cholangitis may be a risk factor for cancer

BACKGROUND/PURPOSE

The relationship between autoimmune pancreatitis (AIP) and malignancy has been reported. However, the potential risk for cancer in patients with immunoglobulin 4 (IgG4)-related sclerosing cholangitis (IgG4-SC) is unclear. The present study aimed to evaluate the incidence of cancer in IgG4-SC patients.

METHODS

We retrospectively collected clinical data for 121 patients diagnosed with IgG4-SC from 7 hospitals. We calculated the standardized incidence ratio (SIR) of cancer in IgG4-SC patients based on the national cancer rates. The SIR of the period after the diagnosis of IgG4-SC were calculated.

RESULTS

The mean follow-up period was 6.4 years, with 121 IgG4-SC patients. During the follow-up period, 26 patients had cancer, and 29 cancers were diagnosed. The SIR of cancer after the diagnosis of IgG4-SC was 1.90 (95% confidence interval [CI] 1.67-2.21). The SIR of pancreatic and bile duct cancer was 10.30 and 8.88, respectively. The SIR of cancer in <1 year, 1-5 years, and >5 years after diagnosis of IgG4-SC were 2.58, 1.01, and 2.44, respectively.

CONCLUSIONS

IgG4-SC patients have a high risk of cancer including pancreatic and bile duct cancer. The risk of cancer was high less <1 year and >5 years after diagnosis of IgG4-SC. Therefore, IgG4-SC patients may require careful long-term follow-up.

Efficacy and safety of colorectal endoscopic submucosal dissection in patients with sarcopenia

BACKGROUND

Endoscopic submucosal dissection (ESD) for early-stage colorectal cancer (CRC) has become a common and useful treatment. Although sarcopenia has been identified as an independent risk factor for complications after surgery for CRC, whether sarcopenia is also an independent risk factor for complications after colorectal ESD remains to be clarified. The aim of this study was to compare the outcomes of colorectal ESD in patients with and those without sarcopenia.

METHODS

This is a retrospective cohort study. A total of 334 patients underwent colorectal ESD for 361 neoplasms at Hiratsuka City Hospital from March 2012 to October 2018. The neoplasms were divided into two groups depending on the presence or absence of sarcopenia in the patients.

RESULTS

Overall, 334 patients underwent colorectal ESD for 361 neoplasms during the study period. We excluded 90 patients (90 neoplasms), and 244 patients (277 neoplasms) were included in the final analysis (134 from the sarcopenia group, 137 from the non-sarcopenia group). The en-bloc resection rate was high and was not significantly different between the sarcopenia group [126/134 (94.1%)] and the non-sarcopenia group [133/137 (97.1%)], P = 0.1778). The rate of perforation and the rate of delayed bleeding were not significantly different between the sarcopenia group and the non-sarcopenia group [6/134 (4.5%) vs. 9/137 (6.6%), P = 0.314, 4/134 (3%) vs. 6/137 (4.4%), P = 0.3885, respectively].

CONCLUSIONS

The presence of sarcopenia did not influence the rate of complications after ESD. Colorectal ESD is safe and effective even in patients with sarcopenia. Prospective multicenter studies are necessary to confirm our results.

The placement of multiple plastic stents still has important roles in candidates for chemotherapy for unresectable perihilar cholangiocarcinoma

BACKGROUND/PURPOSE

Placement of uncovered self-expandable metallic stents (U-SEMSs) of patients with unresectable perihilar cholangiocarcinoma (UPHC) is recommended as the treatment of first choice to address bile stasis. The aim of this study was to determine which of the following two endoscopic stents might be the stent of first choice for the treatment of biliary stasis in patients with UPHC: plastic stents (PSs) or U-SEMSs.

METHODS

U-SEMSs, deployed as a stent-in-stent, were selected as the stents of first choice from 2013 and 2014, while PSs began to be selected as the stents of first choice from 2015 onward.

RESULTS

The median time to recurrent biliary obstruction were 66 days in the PS group (N = 38) and 105 days in the U-SEMS group (N = 37; P = .04). Emergency endoscopy was necessitated in 76.3% (29/38) of patients of the PS group and 54.1% (20/37) of patients of the U-SEMS group (P = .0434). The success rate of the first reintervention was 96.5% (27/29) in the PS group and 55% (11/20) in the U-SEMS group (P = .0002). Sustainable chemotherapy could be carried out in 55.2% of patients in the PS group and 32.4% of patients in the U-SEMS group (P = .0472). Multivariate analysis identified selection of U-SEMS as the stent of first choice as the only independent factor predictive of successful reintervention (P = .0016, odds ratio = 0.058). However, the stent selection was not an independent factor for feasible chemotherapy.

CONCLUSIONS

Plastic stent placement could enhance the success rate of reintervention in patients with UPHC and might be facilitated by sustainable chemotherapy. However, stent selection might not have an influence on the prognosis.

A comparative effectiveness pilot study of teriparatide for medication-related osteonecrosis of the jaw: daily versus weekly administration

We studied the effectiveness of teriparatide (TPTD) for treating medication-related osteonecrosis of the jaw (MRONJ) in patients with osteoporosis and examined differences in the clinical outcomes following daily versus weekly TPTD. The outcomes were significantly improved in the entire patient series and the daily group.

PURPOSE

Teriparatide (TPTD) treatment for Stage II-III medication-related osteonecrosis of the jaw (MRONJ) in osteoporotic patients has yielded promising results in uncontrolled studies. The daily administration and the weekly administration of TPTD have been reported to improve outcomes in MRONJ. Herein, we sought to identify differences in the clinical outcomes of MRONJ patients treated with daily TPTD versus weekly TPTD.

METHODS

We enrolled 13 patients and randomly assigned them to receive either of two treatments: 1×/week 56.5-μg TPTD injection for 6 months (weekly group; n = 6 patients after 1 dropout), or 20-μg TPTD injection daily for 6 months (daily group; n = 6 patients). Patients in both groups received conventional therapy plus intensive antibiotic therapy as necessary. We compared the changes in the patients' clinical stage of MRONJ, bone metabolism, percentage of bone formation, and bone turnover markers between the weekly and daily groups.

RESULTS

TPTD treatment with MRONJ led to partial remission or complete remission in 5 daily-group patients and 3 weekly-group patients. The MRONJ stage was significantly improved from baseline to 6 months of treatment in the entire series of 12 patients (p = 0.008); the weekly group did not show significant improvement, but the daily group did (p = 0.01).

CONCLUSIONS

This study provides the first comparison of clinical outcomes between MRONJ patients who received daily or weekly TPTD injections. Six months of treatment with TPTD realized a significant improvement of MRONJ stage in both the entire patient series and the daily group.

Effect of preventive closure of the frenulum after endoscopic papillectomy: A prospective pilot study

BACKGROUND AND AIM

The usefulness of preventive closure of the frenulum after endoscopic papillectomy (EP) could reduce bleeding. The feasibility and safety of clipping were evaluated in this prospective pilot study.

METHODS

This study involved 40 consecutive patients who underwent preventive closure of the frenulum by clipping just after EP. The outcome data were compared with those of the previous 40 patients in whom no preemptive closure had been performed (no-closure group) (UMIN000014783). Additionally, the bleeding sites were examined.

RESULTS

The clipping procedure was successful in all patients. As compared to the no-closure group, the rate of bleeding (P = 0.026) and period of hospital stay (P < 0.001) were significantly reduced in the closure group. There was no difference in the procedure time between the two groups. Furthermore, the incidence rates of pancreatitis and perforation were comparable in the two groups. The bleeding was noted in the frenulum area rather than at any other site in 90.9% of cases.

CONCLUSION

Preventive closure of the frenulum after EP is an effective, safe, rational, and economical method to reduce the incidence of delayed bleeding, without prolonging the procedure time or increasing the risk of post-procedure pancreatitis perforation.

Estimating transboundary transported anthropogenic sulfate deposition in Japan using the sulfur isotopic ratio

High emissions of air pollutants from Northeast Asia are strongly influenced by air quality as well as by ecosystems. This study investigated the spatiotemporal variations in the sulfur isotopic ratio (δ³⁴S) in atmospheric deposition at eleven monitoring stations in Japan from 2011 to 2016 and estimated the amount of transboundary transported anthropogenic sulfate (TRB) deposition using mass balance calculations. The δ³⁴S of sulfate in precipitation ranged from -0.42 to +22.7‰. Sea salt (SS), TRB, and domestic anthropogenic sources (DOM) were the dominant sources of sulfate deposition in Japan. TRB sulfate deposition was largest on the Sea of Japan side, with an annual average value of 1.5 ± 0.3-6.9 ± 0.5 mg m^-2 d^-1 (36-44%), followed by Mt. Happo (4.5 ± 0.1 mg m^-2 d^-1; 88%), the Pacific Ocean side (1.5 ± 0.8, 4.3 ± 0.9 mg m^-2 d^-1; 24-50%), and the remote islands in the North Pacific Ocean (1.1 ± 0.2, 2.0 ± 0.8 mg m^-2 d^-1; 19-32%). TRB sulfate deposition on the Sea of Japan side was 2-12 times higher in winter and 1-2 times higher in summer than that of DOM. In contrast, TRB sulfate deposition on the Pacific Ocean side was 1.5-3 times higher in summer than in winter due to high precipitation levels. In Tokyo, the annual contribution from DOM sulfate deposition is approximately three times higher than that from TRB. Annual TRB sulfate deposition is lowest at Ogasawara at 1.1 ± 0.2 mg m^-2 d^-1, and the annual oceanic DMS contribution to sulfate deposition is high, accounting for 1.3 mg m^-2 d^-1 (20 ± 6%). The contribution of Asian dust was estimated to be 1-5.2 mg m^-2 d^-1(3-6%), which occurred in a single Asian dust event on the Sea of Japan side.

Clinical features of isolated proximal-type immunoglobulin G4-related sclerosing cholangitis

BACKGROUND AND AIM

Immunoglobulin G4-related sclerosing cholangitis (IgG4-SC) presents as isolated proximal-type sclerosing cholangitis (i-SC). The present study sought to clarify the imaging differences between i-SC and Klatskin tumor. Differences between i-SC and IgG4-SC associated with autoimmune pancreatitis (AIP-SC) were also studied.

METHODS

Differentiating factors between i-SC and Klatskin tumor were studied. Serum IgG4 level, CA19-9 level, computed tomography (CT) findings, cholangiography findings (symmetrical smooth long stricture extending into the upper bile duct [SSLS]), endosonographic features (continuous symmetrical mucosal lesion to the hilar part [CSML]), endoscopic biopsy results, treatment, relapse, and survival were also compared between patients with i-SC and those with AIP-SC.

RESULTS

For a differential diagnosis between i-SC (N = 9) and Klatskin tumor (N = 47), the cut-off value of serum IgG4 level was 150 mg/dL (sensitivity, 0.857, specificity, 0.966). Logistic regression analysis indicated that serum IgG4 level, presence of SSLS, presence of CSML, and presence of swollen ampulla are independent factor for identifying i-SC. Relapse rate was significantly higher in the IgG4-SC with AIP group than in the i-SC group (log rank, P = 0.046).

CONCLUSION

Isolated proximal-type sclerosing cholangitis presents as a nodular lesion with SSLS and/or CSML mimicking a Klatskin tumor. Those endoscopic features might provide a diagnostic clue for i-SC. i-SC is likely to have a more favorable prognosis than IgG4-SC with AIP.

Effect of surface charge, particle size, and modification by polyethylene glycol of liposomes on their association with Caco-2 cells across an unstirred water layer

For the development of orally available liposomes, understanding the interaction of liposomes with the intestinal mucosa is important. An unstirred water layer (UWL) on the intestinal epithelium surface is a considerable permeability barrier for lipophilic drugs. Therefore, the effects of an UWL on liposome transport across intestinal epithelial cells must be elucidated. We evaluated the effects of the surface charge, particle size, and polyethylene glycol (PEG) modification of liposomes on their association with Caco-2 cells across an UWL. When the association of cationic liposomes with Caco-2 cells was evaluated under a reduction in UWL thickness by shaking, the uptake and/or amount of surface-bound cationic liposomes in cells was increased significantly in a shaking rate-dependent manner. The uptake and/or amount of surface-bound neutral liposomes were increased only at the highest shaking rate. No significant differences in the cellular association of anionic liposomes and PEG-modified liposomes were observed with or without shaking. The association of large liposomes with Caco-2 cells was affected considerably by an UWL compared with that of small liposomes. These results suggest that an UWL affects the surface binding and subsequent uptake of liposomes in Caco-2 cells according to their particle size, surface charge, and PEG modification.

Feasibility of Endoscopic Papillary Large Balloon Dilation in Patients with Difficult Bile Duct Stones without Dilatation of the Lower Part of the Extrahepatic Bile Duct

Background/Aims

There is no consensus for using endoscopic papillary large balloon dilation (EPLBD) in patients without dilatation of the lower part of the bile duct (DLBD). We evaluated the feasibility and safety of EPLBD for the removal of difficult bile duct stones (diameter ≥10 mm) in patients without DLBD.

Methods

We retrospectively reviewed the records of 209 patients who underwent EPLBD for the removal of bile duct stones from October 2009 to July 2014. Primary outcomes were the clearance rate and additional mechanical lithotripsy. Secondary outcomes were the incidence of complications and recurrence rate.

Results

Fifty-seven patients had DLBD (27.3%), and 152 did not have DLBD (72.7%). There were no significant differences in the overall success rate or the use of mechanical lithotripsy. Success rate during the first session and procedure time were better in the DLBD than the without-DLBD group (75.7% vs 66.7%, 48.1±23.0 minutes vs 58.4±31.7 minutes, respectively). As for complications, there were no significant differences in the incidence of pancreatitis, perforation or bleeding after endoscopic retrograde cholangiopancreatography. The recurrence rate did not differ significantly between the two groups.

Conclusions

EPLBD is a useful and safe method for common bile duct stone removal in patients without DLBD.

Lubiprostone improves intestinal permeability in humans, a novel therapy for the leaky gut: A prospective randomized pilot study in healthy volunteers

BACKGROUND AND AIMS

The barrier function of the small intestinal mucosa prevents the introduction of undesired pathogens into the body. Breakdown of this barrier function increases intestinal permeability. This has been proposed to induce not only gastrointestinal diseases, including inflammatory bowel disease and irritable bowel syndrome, but also various other diseases, including allergies, diabetes mellitus, liver diseases, and collagen diseases, which are associated with this so called "leaky gut syndrome." As such, a method to prevent leaky gut syndrome would have substantial clinical value. However, no drugs have been demonstrated to improve disturbed intestinal permeability in humans to date. Therefore, we investigated whether a drug used to treat chronic constipation, lubiprostone, was effective for this purpose.

METHODS

Healthy male volunteers were treated with lubiprostone (24 μg/day) for 28 days. Intestinal permeability was evaluated by measuring the lactulose-mannitol ratio (LMR) after administration of diclofenac and compared with an untreated group. The examination was conducted three times in total, i.e., at baseline before diclofenac administration and after 14 and 28 days of lubiprostone treatment. Blood endotoxin activity was also evaluated at the same time points.

RESULTS

The final analysis was conducted on 28 subjects (14 in the lubiprostone group and 14 in the untreated group). The LMR after 28 days of treatment was significantly lower in the lubiprostone group than that in the untreated group (0.017 vs. 0.028, respectively; 95% confidence interval, -0.022--0.0001; p = 0.049). Blood endotoxin activity exhibited almost no change over time in the lubiprostone and untreated groups and displayed no significant differences at any time point of examination.

CONCLUSIONS

This study is the first to report an improvement in leaky gut using an available drug in humans. The result suggests that lubiprostone may prevent and ameliorate "leaky gut syndrome". However, a pivotal trial is needed to confirm our finding.

Intravenous injection of low-dose flurbiprofen axetil for preventing post-ERCP pancreatitis in high-risk patients: An interim analysis of the trial

Background and study aims: Several meta-analyses and randomized control trials have demonstrated the efficacy of rectal nonsteroidal anti-inflammatory drugs for preventing post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP). Diclofenac or indomethacin was administered at a dose of 100 mg in those studies, which may be too high for Asian population. In addition, rectal administration can be considered complicated. Patients and methods: This study was a prospective, randomized, placebo-controlled trial. Patients with a PEP risk score ≥ 1 were randomly assigned to receive intravenous injection of 50 mg flurbiprofen axetil (flurbiprofen group) or saline only (placebo group). The primary outcome was reduced PEP. The secondary outcome was amylase level after 2 hours of ERCP as a predictor of PEP. (Clinical Trials.gov, ID UMIN000011322) Results: In total, 144 patients were enrolled from August 2013 to March 2015. We performed an interim analysis of the first 100 patients: 47 received flurbiprofen axetil and 53 received placebo. PEP occurred in 11 patients (11 %): 2 of 47 (4.3 %) in the flurbiprofen group and 9 of 53 (17 %) in the placebo group (P = 0.042). Relative risk reduction was 62.4 %. Hyperamylasemia did not differ significantly (17.0 % vs. 26.4 %, P = 0.109). This analysis resulted in early termination of the study for ethical reasons. Conclusions: Intravenous injection of low-dose flurbiprofen axetil after ERCP can reduce the incidence of PEP in high-risk patients.

OPTIMAL WAVELENGTH SELECTION ON HYPERSPECTRAL DATA WITH FUSED LASSO FOR BIOMASS ESTIMATION OF TROPICAL RAIN FOREST

Above-ground biomass prediction of tropical rain forest using remote sensing data is of paramount importance to continuous large-area forest monitoring. Hyperspectral data can provide rich spectral information for the biomass prediction; however, the prediction accuracy is affected by a small-sample-size problem, which widely exists as overfitting in using high dimensional data where the number of training samples is smaller than the dimensionality of the samples due to limitation of require time, cost, and human resources for field surveys. A common approach to addressing this problem is reducing the dimensionality of dataset. Also, acquired hyperspectral data usually have low signal-to-noise ratio due to a narrow bandwidth and local or global shifts of peaks due to instrumental instability or small differences in considering practical measurement conditions. In this work, we propose a methodology based on fused lasso regression that select optimal bands for the biomass prediction model with encouraging sparsity and grouping, which solves the small-sample-size problem by the dimensionality reduction from the sparsity and the noise and peak shift problem by the grouping. The prediction model provided higher accuracy with root-mean-square error (RMSE) of 66.16 t/ha in the cross-validation than other methods; multiple linear analysis, partial least squares regression, and lasso regression. Furthermore, fusion of spectral and spatial information derived from texture index increased the prediction accuracy with RMSE of 62.62 t/ha. This analysis proves efficiency of fused lasso and image texture in biomass estimation of tropical forests.

Development of high-order harmonic focusing system based on ellipsoidal mirror

We have developed a focusing system for extreme ultraviolet light produced by high-order harmonic generation. An ellipsoidal mirror with a precise surface shape was fabricated and installed into the focusing system. A rigid mirror manipulator and a beam profiler were employed to perform precise and stable mirror alignment. As a demonstration of the focusing performance, high-order harmonics in the wavelength range of 13.5-19.5 nm were successfully focused into a 2.4 × 2.3 μm(2) spot.

Stent placement above the sphincter of Oddi permits implementation of neoadjuvant chemotherapy in patients with initially unresectable Klatskin tumor

BACKGROUND AND STUDY AIMS

Neoadjuvant chemotherapy (NAC) may lead to a successful margin-negative resection in patients with initially unresectable locally advanced Klatskin tumor (IULAKT). Use of removable plastic stents is preferable for the safe implementation of NAC in patients with IULAKT to reduce the risk of recurrent cholangitis. Our aim was to evaluate the efficacy associated with the use of plastic stents placed across the stenosis and above the papilla (above stent) during NAC.

PATIENTS AND METHODS

In this study, we stratified the patients into two groups chronologically with respect to the period of stent placement: above stent group (n = 17) and across stent group (n = 23) (plastic stent across the sphincter of Oddi).

RESULTS

The median stent patency period was 99 days in the above stent group and 31 days in the across stent group (P < 0.0001). The number of stents (P = 0.017) and the rate of emerging undrained cholangitis areas (P = 0.025) were significantly reduced in the above stent group than the counterpart. Regarding time to recurrent biliary obstruction, the above stent group had a longer duration than the across stent group (log rank test, P = 0.004). Length of hospital stay was significantly shorter for the above stent group than the across stent group (P = 0.0475). Multivariate analysis revealed that above stent placement (odds ratio = 33.638, P = 0.0048) was significantly associated with stent patency over a period of 90 days.

CONCLUSIONS

Above stent placement should be considered for the relief of biliary obstruction and potentially reduces the cost for patients with IULAKT scheduled to receive NAC.

Expression of variant CD44, exon 6 in patients with metastatic pulmonary tumor

High expression ratios of CD44 variant 6 (CD44 V6) in patients with metastatic pulmonary tumor were found in those with primary lesions of cancer of the colon, uterus, larynx, liver and osteosarcoma. It was clarified that patients showing expression of CD44 variant 6 likely revealed pulmonary metastasis at earlier time following operations of primary cancer (p<0.05). CD44 V6, an adhesion molecule, was a factor to participate in pulmonary metastases from various organ cancers. No significant correlation was observed in survival between patients with CD44 V6 positive versus negative tumors, except laryngeal tumor after resection of primary or metastatic lung tumor. CD44 V6 related to its invasive and further metastatic functions in metastatic lung tumor. We suggest that cancer cells expressing the CD44 molecule especially V6 may adhere to vascular endothelium and hyaluronic acid in the lung. And cancer cells without this molecule liberated from the primary focuses hardly adhere to the pulmonary tissues supposedly resulting in delayed metastases and proliferations in the pulmonary tissues.

PP075. Endothelial dysfunction may be impaired by increased oxidative stress in preeclamptic women

INTRODUCTION

The essential pathogenesis in preeclampsia is vasospasm induced by endothelial cell injury. The vascular endothelium regulates vascular smooth muscle tone by producing vasoconstrictors and vasodilators, such as nitric oxide (NO). Recently, it has been reported that the levels of oxidative stress are increased and they may impair endothelial NO production and induce endothelial dysfunction in preeclampsia.

OBJECTIVES

To determine whether maternal release of oxygen free radical and antioxidants are associated with maternal vascular endothelial cell injury, we measured serum parameters of oxidative stress and endothelial function during pregnancy in women with or without preeclampsia.

METHODS

We evaluated 20 participants with uncomplicated pregnancies, 15 with mild preeclampsia, and 18 with severe preeclampsia. Plasma concentrations were measured for derivatives of reactive oxygen metabolites (d-ROMs) and biological antioxidant potential (BAP) as markers of oxygen free radicals and antioxidants, respectively. Flow-mediated vasodilation (FMD) was also assessed as a marker of endothelial function.

RESULTS

D-ROMs were increased in the maternal blood of the severe preeclamptic group compared with the control group (681.0±239.0 vs 478.6±101.4 CARR U, P<0.001), but not in the mild preeclamptic group (562.0±106.5 CARR U). Plasma BAP levels did not change significant in all three groups. The proportion of d-ROMs to BAP was higher in the severe preeclamptic group than in controls (0.28±0.11 vs 0.21±0.05, P<0.01), but not in the mild preeclamptic group (0.24±0.08). FMD was significantly decreased in both preeclamptic groups (severe, 4.3±3.3%, P<0.001; mild, 6.5±3.6%, P<0.001) compared with controls (10.5±2.3%), but FMD in the severe preeclamptic group was significantly greater than in the mild preeclamptic group. A negative correlation between FMD and d-ROM concentrations was observed in all participants (r=-0.376, P<0.05), and the ratio of serum d-ROMsto BAP correlated negatively with FMD (r=-0.413, P<0.05) in all participants.

CONCLUSION

We found that the production of oxygen free radicals increased, but not the production of antioxidants which decreased, as a result, an imbalance between reactive oxygen species formation and antioxidant defence mechanisms may have impaired endothelial function in preeclamptic women.

Video-assisted thoracic surgery for lung cancer in hemodialysis patients

INTRODUCTION

In recent years, the number of hemodialysis patients has been continuously increasing. At the same time, the use of video-assisted thoracic surgery (VATS) for lung cancer has also increased. However, reports of the outcome of VATS in hemodialysis patients are still quite rare.

METHODS

From 1995 to 2011, 14 patients with non-small cell lung cancer who were also receiving hemodialysis underwent lung resection by open thoracotomy or VATS at our institution. These patients were divided into two groups as follows: open (five men and four women, mean age: 68.7 years) and (2) VATS (three men and two women, mean age: 64.0 years). We compared the clinical outcomes of these two groups.

RESULTS

Lobectomy was performed in eight patients in the open group, including one patient who also underwent a pneumonectomy, and in four patients in the VATS group, including one who also underwent a wedge resection. There were no significant difference between the groups' operation times, intraoperative blood loss, length of postoperative chest drainage, and length of postoperative hospitalization. There were no hospital deaths in either group. The 5-year survival rate was 42.9% in the open group and 37.5% in the VATS group. This difference was not significant (P=0.73).

CONCLUSION

VATS lung resection for lung cancer patients on hemodialysis is considered an acceptable treatment modality, though the long-term survival rate of such patients is relatively low, which can be attributed to the diseases underlying the need for hemodialysis.

Prognosis of patients after pulmonary artery plasty for non-small cell lung cancer

OBJECTIVE

We evaluated the clinical outcomes of patients after lung resection with pulmonary artery (PA) plasty for non-small cell lung cancer (NSCLC).

METHODS

From 1995 to 2006, 36 patients (26 males and 10 females) with NSCLC underwent lobectomy or segmentectomy with PA plasty at our institution. The mean age of the patients was 65.9 years old (range 45-87 years old). There were 17 left upper lobectomies, 10 right upper lobectomies, five left lower lobectomies, two right upper-and-middle bilobectomies, one right lower lobectomy, and one left upper division segmentectomy. Both bronchoplasty and PA plasty were performed in 15 patients. Six patients received preoperative chemotherapy, and one had preoperative radiotherapy.

RESULTS

The postoperative morbidity rate was 27.8 % (10/36), and the mortality rate (30 days) was 2.8 % (1/36). One patient underwent completion pneumonectomy on postoperative day 13. Macroscopic residual cancer was identified in two patients at the thoracic wall and aorta, respectively; microscopic residual cancers were identified in two patients at the stumps of the pulmonary artery and in one patient at the bronchial stump. Postoperative radiation therapy was additionally given to those four patients, except one. The 5-year survival rate for all patients was 51.8 %. There was no significant difference in the 5-year survival rate between clinical N (cN) 0-1 patients and cN2 patients. However, in pathological N (pN) 0-1 patients, the 5-year survival rate was significantly better than that of pN2 patients (71.9 % versus 0.0 %; P < 0.001).

CONCLUSIONS

PA plasty for NSCLC is acceptable and highly recommended for pN0-1 patients. Strict patient selection should be considered so as to avoid surgical operations in patients with pN2 staging.

Electronic structure of disjoint diradical 4,4'-bis(1,2,3,5-dithiadiazolyl) thin films

The electronic structure of the thiazyl diradical, 4,4'-bis(1,2,3,5-dithiadiazolyl) (BDTDA), has been investigated by ultraviolet photoemission spectroscopy. Stacked BDTDA dimers showed an energy band dispersion of about 0.3 eV for the highest occupied molecular orbital in the direction of the surface normal of the BDTDA solid film. The pi-orbital overlap between the stacked dimers therefore evolves into a quasi one-dimensional energy band along the dimer stacking direction.

Cross-sectional study on respiratory effect of toner-exposed work in manufacturing plants, Japan: pulmonary function, blood cells, and biochemical markers

The aim of the study is to examine the relationship between toner-exposed work and health indices related to respiratory disorders and to confirm the baseline of a cohort study to clarify the effect of toner exposure in manufacturing plants. Subjects were 1614 male workers (809 toner-exposed workers and 805 referents) who were engaged in toner manufacturing plants in Japan (Fuji Xerox Co., Ltd). The age of subjects was from 19 to 59 years, and the average age was 40.2 years(median 40 years, SD 7.67). We conducted a pulmonary function test (PEFR, VC, FVC, FEV(1.0)%, V25/Ht) and a blood cell test (RBC, Hb, Hct, Plt, WBC, cell contents of WBC) and measured biochemical indices in blood (ALT, AST, gamma-GTP, CRP, IgE) and 8-hydroxy-2'-deoxyguanosine (8-OHdG) in urine. Student t-test and logistic regression analysis were applied to compare between the toner-exposed workers and the referents and to analyze the relationship among indices of effects and independent factors. There was no significant difference between the two groups in blood cell count and biochemical indices. Inflammation- and allergy-related markers such as 8OHdG and IgE also showed no significant difference between toner-exposed workers and the referents. The influence of smoking on pulmonary function indices was observed, but there was no relationship between the pulmonary function and toner-exposed work. In this article, we report a preliminary cross-sectional analysis in the subjects of a cohort study. No difference in pulmonary function indices was observed between the toner-exposed workers and the referents, and there was no consistent relationship between the exposure status and examined indices; however, the prevalence of subjective respiratory symptoms was higher in the exposed workers as presented in another report. Further analysis is important in the ongoing cohort study to clarify the effect of toner exposure on respiratory systems.

[Thoracic drainage]

The thoracic drainage system is a sophisticated and useful technology, especially in thoracic surgery. therefore, lung resections are able to be performed safely in spite of air leaks which are a common problem after pulmonary resection. The thoracic drainage system is called the 3 bottles system, which are consisted of a drainage-bottle, an underwater-seal-bottle, and a continuous low-pressure-suction devise. Based on this basic structure, a lot of convenient thoracic drainage products such as a small thoracic drainage kit for pneumothorax have been developed. Some chest tubes which changed tubal form for efficient drainage are developed as well. However, each product has both advantages and disadvantages, then, we should understand characteristics of those new products and know the physiology of respiratory, when we use them.

Dendritic cells and macrophages in the genitourinary tract

Dendritic cells (DCs) and macrophages are antigen-presenting cells (APCs) that are important in innate immune defense as well as in the generation and regulation of adaptive immunity against a wide array of pathogens. The genitourinary (GU) tract, which serves an important reproductive function, is constantly exposed to numerous agents of sexually transmitted infections (STIs). To combat these STIs, several subsets of DCs and macrophages are strategically localized within the GU tract. In the female genital mucosa, recruitment and function of these APCs are uniquely governed by sex hormones. This review summarizes the latest advances in our understanding of DCs and macrophages in the GU tract with respect to their subsets, lineage, and function. In addition, we discuss the divergent roles of these cells in immune defense against STIs as well as in maternal tolerance to the fetus.

[Sleeve lobectomy for primary lung cancer]

We reviewed Fukuoka University Hospital thoracic surgery data base of 60 sleeve lobectomy (SL) and 40 pneumonectomy (PN) [for T1-3 disease] for primary lung cancer during 1993-2006. Morbidity rates were 20.0% and 37.5% in SL and PN group, respectively (p = 0.054). Three and 1 patient from PN and SL group, respectively, presented with bronchial anastomotic complications. Multivariate analysis showed that adjuvant chemotherapy and preoperative concomitant respiratory disease, but not the surgical procedures SL or PN, were risk factors for surgical morbidity. SL requires special consideration on its surgical technique either bronchial anastomosis or associated angioplastic procedure, however, it is safe and valuable less invasive surgical option especially for elderly patients.

Ezrin is a key element in the human vagina

OBJECTIVE

The vagina is a complex tubular structure that has reproductive, support and barrier functions. These depend on the cytoarchitecture of the vaginal cells, which is controlled by key proteins. Cytoskeletal proteins determine cell polarity and membrane specializations by integrating the actin cytoskeleton with cell membranes. This integration is the domain of cytoskeletal proteins including the MERM protein family (moesin-ezrin-radixin-Merlin). Nothing is known about the cyto-localization of the MERM's in the vaginal epithelium or how it influences the cytoarchitecture of the vaginal epithelium and stroma.

DESIGN

Full-thickness human vaginal fornix samples were obtained from 20 normal human specimens obtained at surgery for pelvic relaxation. Light- and electron microscopical immunohistochemistry (IHC) were used to identify and study activation and cellular localization of immuno-reactive-ezrin (ir-ezrin), a prototypical MERM.

RESULTS

Ir-ezrin was identified in the stratified squamous vaginal epithelium and connective tissue (fibroblasts, blood vessels and leucocytes). "H" scoring indicated that ir-ezrin staining is denser in the vaginal epithelium than in other layers, that the ir-ezrin staining was associated with increased keratinization and with the size of the tight junctions (p<0.01). Both the amounts and localization of ir-ezrin were associated with high levels of estrogen, identified by the menstrual history and keratinization of the superficial vaginal epithelium. The density of stromal ir-ezrin was increased in the presence of dense epithelial keratinization. Immuno-reactive-ezrin staining was most pronounced near the cell membranes of both keratinized and non-keratinized epithelium, indicating that ezrin activation (unfolding and movement to the membrane) had occurred. Ultra-structural examination of the epithelium showed intra-cellular ir-ezrin to be localized to junctional complexes that have been associated with decreased mucosal penetration by microorganisms. Ir-ezrin was widely distributed throughout stromal fibro-muscular cell, vessels and immunocytes.

CONCLUSIONS

MERM's, represented by ezrin, are widely present in the vaginal wall. This has implications for the strength and resilience of this tubular structure and may be the case in other internal genital tissues. Ezrin's localization and association with cell specializations indicate that in the vagina, as in other tissues, ezrin likely modulates vaginal cell-cell interactions including the changing vaginal cellular interface with the external environment, the regulation of the elasticity of the vagina, and the regulation of microbial and chemical traffic that determine the pH and microbial environment of the vagina. In other work we have shown that ezrin expression is induced by estradiol. The increase of ir-ezrin staining during the appearance of keratinization and maturation of the vaginal cytology indicates that estrogen may regulate vaginal ezrin and thereby the properties of the vaginal wall and epithelium.

New trainer for video-assisted thoracic surgery lobectomy

BACKGROUND

Only a few simulators are available which offer training in video-assisted thoracic surgery (VATS). We have developed a VATS training model for surgeons.

METHODS

The simulator consists of a training module housing three disposable components: the lung (made of polyurethane), the bronchus, and the artificial circulatory pulmonary vessels (made of polyvinyl chloride), connected to a pump. VATS procedures were videotaped and evaluated using a checklist assessment method.

RESULTS

This unique module has been tested at several VATS seminars in Japan. In the questionnaire, training participants strongly agreed that the trainer was helpful and prepared them well for VATS lobectomy prior to performing actual surgery. Evaluation of the dexterity score for thoracoscopic surgery with our simulator correlated with the surgeons' experience with actual surgery. Technical factors were well taught using this model.

CONCLUSIONS

Our unique trainer may enhance the skill of VATS surgeons at a national level.

Comparison between a Case-Matched Analysis of Left Upper Lobe Trisegmentectomy and Left Upper Lobectomy for Small Size Lung Cancer Located in the Upper Division

BACKGROUND

Although an increasing number of approaches for pulmonary segmentectomy to treat early lung cancer are being used, there have been few reports on left upper lobe trisegmentectomy, which is midway between single segmentectomy and lobectomy, for lung cancer.

METHODS

We retrospectively reviewed the medical charts of 86 clinical stage I case-matched patients with a tumor size of less than 2.0 cm in diameter located in the left upper division who underwent resection between June 1998 and December 2005. The patients were divided into two groups as follows: LTS (31), left upper lobe trisegmentectomy; LUL (55), left upper lobectomy. We evaluated these groups with respect to several factors.

RESULTS

The characteristics of the two groups (LTS vs. LUL) demonstrated no significant differences with respect to gender, histological type, tumor size, or upstaging of pathological node, or the mode of video-assisted thoracic surgery (VATS). Patients with LTS had a significantly lower pulmonary function compared to the LUL group. There were no significant differences between the two groups with respect to factors such as blood loss and duration of chest tube drainage. Morbidity and recurrence rates did not differ between the two groups, and there was no mortality in our series. The overall survival rate at 5 years was 69.7 % in the LTS and 72.5 % in the LUL group. There was no significant difference in survival rates between the LTS and the LUL group after resection.

CONCLUSION

LTS may be suitable as a standard treatment if the tumor is small and the suspected margins are well away from the lingula.