[Three Cases of No. 16 Lymph Node Metastasis-Positive Gastric Cancer Successfully Treated with Chemotherapy and Para-Aortic Lymph Node Dissection]

Chemotherapy is standard treatment for Stage Ⅳ advanced gastric cancer(AGC)positive for No. 16 lymph node(LN) metastasis, but the significance of conversion surgery remains unclear. S-1 plus CDDP(SP), primary lesion resection+ para-aortic LN dissection(PAND), and postoperative recurrence-free survival are reported. Case 1: A 70-year-old woman had AGC with para-aortic LN metastases(tub1, HER2 score 3+, cT3N2M1, cStage Ⅳ). Four courses of SP plus trastuzumab were administered, which shrank the primary tumor and metastatic LNs. She underwent distal gastrectomy with D2+PAND (No. 16a2 int-b1 int). Histopathology showed metastasis to No. 16 LN, with Grade 2 histological effect. She underwent adjuvant chemotherapy with S-1 and 4-year recurrence-free follow-up. Case 2: An 80-year-old man with AGC rand para- aortic LN metastases(por, cT3N2M1, cStage Ⅳ)underwent 4 courses of SP, which shrank the primary tumor and metastatic LNs. He underwent total gastrectomy with D2+PAND(No. 16a2 lat)dissection. Histopathology showed no residual tumor cells in LNs. Follow-up for 3 years has shown no recurrence without chemotherapy. Case 3: A 50-year-old woman with epigastric pain and anemia had AGC with para-aortic LN metastases(tub2, cT3N3M1, cStage Ⅳ). She underwent distal gastrectomy with D2+PAND(No. 16a2 int-b1 lat). After 1-year chemotherapy with SP, follow-up for 5 years showed no recurrence. In AGC with para-aortic LN metastases, long-term survival can be expected by combining selective PAND with SP therapy.

Inhibitory effect of the Kampo medicinal formula Yokukansan on acute stress-induced defecation in rats

OBJECTIVES

Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder with symptoms of abnormal defecation and abdominal discomfort. Psychological factors are well known to be involved in onset and exacerbation of IBS. A few studies have reported effectiveness of traditional herbal (Kampo) medicines in IBS treatment. Yokukansan (YKS) has been shown to have anti-stress and anxiolytic effects. We investigated the effect of YKS on defecation induced by stress and involvement of oxytocin (OT), a peptide hormone produced by the hypothalamus, in order to elucidate the mechanism of YKS action.

METHODS AND RESULTS

Male Wistar rats were divided into four groups; control, YKS (300 mg/kg PO)-treated non-stress (YKS), acute stress (Stress), and YKS (300 mg/kg PO)-treated acute stress (Stress+YKS) groups. Rats in the Stress and Stress+YKS groups were exposed to a 15-min psychological stress procedure involving novel environmental stress. Levels of plasma OT in the YKS group were significantly higher compared with those in the Control group (P < 0.05), and OT levels in the Stress+YKS group were remarkably higher than those in the other groups (P < 0.01). Next, rats were divided into four groups; Stress, Stress+YKS, Atosiban (OT receptor antagonist; 1 mg/kg IP)-treated Stress+YKS (Stress+YKS+B), and OT (0.04 mg/kg IP)-treated acute stress (Stress+OT) groups. Rats were exposed to acute stress as in the previous experiment, and defecation during the stress load was measured. Administration of YKS or OT significantly inhibited defecation; however, administration of Atosiban partially abolished the inhibitory effect of YKS. Finally, direct action of YKS on motility of isolated colon was assessed. YKS (1 mg/mL, 5 mg/mL) did not inhibit spontaneous contraction.

CONCLUSION

These results suggested that YKS influences stress-induced defecation and that increased OT secretion may be a mechanism underlying this phenomenon.

Yokukansan (Kampo medicinal formula) prevents the development of morphine tolerance by inhibiting the secretion of orexin A

Background

Yokukansan (YKS), a traditional herbal (Kampo) medicine consisting of seven herbs, is effective in the treatment of pain disorders, such as headache, postherpetic neuralgia, fibromyalgia, and trigeminal neuralgia, and we have previously shown it to be effective against morphine analgesic tolerance in rats. It has been reported that orexin receptor antagonists prevent the development of morphine tolerance and that YKS inhibits the secretion of orexin A in the hypothalamus. This study examined whether the inhibition of the secretion of orexin A by YKS is one mechanism underlying its effect against morphine analgesic tolerance.

Methods

Male Wistar rats were administered a subcutaneous injection of morphine hydrochloride (10 mg/kg/day) for 5 days. One group was preadministered YKS, starting 3 days before the morphine. The withdrawal latency following thermal stimulation was measured daily using a hot plate test. On day 5, the levels of orexin A in the plasma and the midbrain were measured, and the appearance of activated astrocytes in the midbrain was examined by immunofluorescence staining.

Results

The preadministration of YKS prevented the development of morphine tolerance. The repeated administration of morphine significantly increased the plasma and midbrain levels of orexin A and the activation of astrocytes. These increases were significantly inhibited by the preadministration of YKS.

Conclusion

These results suggest that the preadministration of YKS attenuated the development of antinociceptive morphine tolerance and that the inhibition of orexin A secretion may be one mechanism underlying this phenomenon.

Influence of IL13 on Periostin Secretion by Synoviocytes in Osteoarthritis

BACKGROUND

Our previous research provided evidence of periostin increase in parallel with interleukin-13 (IL13) increase in the synovial fluid of patients with osteoarthritis (OA). The reaction cascade from IL13 to periostin, however, remains unidentified. We, therefore, tested the hypothesis that periostin secretion is affected downstream of IL13.

MATERIALS AND METHODS

OA synoviocytes were cultured under different concentrations of IL13. Periostin content in culture supernatants and the level of signal transducer and activator of transcription 6 (STAT6) in the cultured cells were measured using enzyme-linked immunosorbent assay (ELISA). Moreover, the influence of dexamethasone and leflunomide on periostin production in relation to the effect of IL13 on the cells was also examined.

RESULTS

Periostin content in culture supernatants and the level of STAT6 in cultured cells were significantly increased by IL13. The increase of periostin was significantly inhibited by dexamethasone and leflunomide.

CONCLUSION

Periostin may be up-regulated in OA synoviocytes via STAT6 downstream of IL13.

Antistress effects of Kampo medicine "Yokukansan" via regulation of orexin secretion

OBJECTIVE

Various stressors induce stress responses through the hypothalamic-pituitary-adrenal and the sympathetic-adrenal-medullary axes, which are regulated, in part, by orexin. For example, secretion of orexin in the hypothalamus is increased in rats exposed to the stress of social isolation for 1 week. In this study, the antistress effects of Kampo medicine Yokukansan (YKS) via the regulation of orexin secretion were investigated using a rat model.

METHODS AND RESULTS

The administration of 300 mg/kg per day of YKS to rats for 1 week significantly decreased the plasma orexin levels compared with non-treated rats, whereas the administration of 1,000 mg/kg of YKS had no effect on orexin levels. Therefore, 300 mg/kg of YKS was an effective dose for controlling orexin secretion. Subsequently, rats were divided into group-housed control (Con), individually housed stress (Stress), and individually housed YKS (300 mg/kg)-treated stress (Stress + YKS) groups. After 1 week, a resident-intruder aggression test was performed, and the plasma levels of orexin and corticosterone were measured. In the Stress group, aggressive behavior and the levels of corticosterone and orexin significantly increased compared with the Con group; however, these effects were inhibited in the Stress + YKS group. Further, an orexin receptor antagonist (TCS 1102; 10 mg/kg) was intraperitoneally administered to rats exposed to isolation stress to determine whether orexin was involved in stress responses. Under these conditions, aggressive behavior and the level of corticosterone significantly decreased compared with the Stress group.

CONCLUSION

These results suggest that orexin is involved in the control of stress response and that YKS exerts an antistress effect via the regulation of orexin secretion.

Quantification of glycated hemoglobin by electrospray ionization mass spectrometry

Glycated hemoglobin, considered to be the best index for the treatment of diabetes mellitus, was measured by electrospray ionization mass spectrometry (ESI/MS) according to the method proposed by Morris et al. at the 44th ASMS Conference on Mass Spectrometry and Allied Topics, 1996. They compared the values obtained by MS and affinity chromatography. Here, the values obtained by ESI/MS were compared with those obtained by high-performance liquid chromatography and by latex agglutination immunoassay. Whole blood samples were diluted 500 fold with 0.2% formic acid-50% acetonitrile solution and 5 microliters of the diluted solution was injected with the ESI/MS system (TSQ 7000) via a sample loop. The within-run and between-run relative standard deviations of the ratio of glycated and non-glycated beta-chain were less than 5%. The correlation coefficients between ESI/MS and conventional methods were higher than 0.96. However, considerable discrepancies were observed among methods. ESI/MS will allow reproducible measurements of glycated hemoglobin and will be useful in the quality control of HbA1c measurement by other principles and also in routine clinical laboratory tests.