Pure laparoscopic hepatectomy for hepatocellular carcinoma patients with severe liver cirrhosis

Hepatocellular carcinoma often arises in cirrhotic livers. Patients with severe liver cirrhosis who undergo hepatectomy often develop postoperative liver failure, even if the hepatectomy is limited. Here, we report six patients with severe liver cirrhosis (Child-Pugh B/C and indocyanine green retention rate at 15 min ≥ 40%) who underwent pure laparoscopic hepatectomy. Their perioperative course was favorable and comparable to that of other hepatocellular carcinoma patients with mild-moderate liver cirrhosis. In patients with severe liver cirrhosis, pure laparoscopic hepatectomy minimizes the disturbance in collateral blood and lymphatic flow caused by laparotomy and liver mobilization, as well as the mesenchymal injury caused by compression of the liver. It limits complications such as massive ascites, which can lead to severe postoperative liver failure. Good candidates for the procedure include patients with severe liver cirrhosis who have tumors on the liver surface and in whom adaptation to ablation therapy is difficult and/or who experience local recurrence after repeat treatments.

Circulating microRNAs in plasma of patients with oesophageal squamous cell carcinoma

Background:

Several recent studies demonstrated that microRNAs (miRNAs) are stably detectable in plasma/serum. We hypothesised that plasma miRNAs concentrations contributed to potential biomarkers in patients with oesophageal squamous cell carcinoma (ESCC).

Methods:

We selected three oncogenic miRNAs (miR-21, miR-184, miR-221) and one tumour suppressive miRNA (miR-375), which are frequently reported in squamous cell carcinoma, as candidate targets for this plasma miRNA assay. This study was divided into three steps: (1) Determination of appropriate plasma miRNAs in preliminary tests. (2) Evaluation of whether the plasma miRNA assays could monitor tumour dynamics. (3) Validation study on the clinical application of plasma miRNA assays in 50 ESCC patients and 20 healthy volunteers.

Results:

(1) In preliminary tests, the plasma level of miR-21 was significantly higher (P=0.0218) and that of miR-375 (P=0.0052) was significantly lower in ESCC patients than controls. (2) The high plasma miR-21 levels reflected tumour levels in all cases (100%). The plasma level of miR-21 was significantly reduced in postoperative samples (P=0.0058). (3) On validation analysis, the plasma level of miR-21 tended to be higher in ESCC patients (P=0.0649), while that of miR-375 was significantly lower (P<0.0001) and the miR-21/miR-375 ratio was significantly higher (P<0.0001) in ESCC patients than in controls. The value of the area under the receiver-operating characteristic curve (AUC) was 0.816 for the miR-21/miR-375 ratio assay. Patients with a high plasma level of miR-21 tended to have greater vascular invasion (P=0.1554) and to show a high correlation with recurrence (P=0.0164).

Conclusion:

Detection of circulating miRNAs might provide new complementary tumour markers for ESCC.

Insufficient lymph node dissection is an independent risk factor for postoperative cancer death in patients undergoing surgery for stage II colorectal cancer

BACKGROUND

Surgical resection is the most effective treatment for patients with stage II colorectal cancer (CRC). However, a few patients with early-phase CRC suffer postoperative cancer death.

AIMS

To investigate the risk factors for postoperative cancer death in patients who undergo surgery for stage II CRC.

METHODS

Prognostic significance was analyzed by χ(2) test, univariate analyses, Kaplan-Meier analysis and log-rank test using clinicopathological factors from the database.

RESULTS

A total of 205 patients with stage II CRC were evaluated. Age (≤ 65/>65 years), venous invasion (negative/positive), number of dissected lymph nodes (≤ 9/≥ 10), grade of lymph node dissection (sufficient/insufficient) and albumin level (< 3.5/≥ 3.5 g/dl) were associated with shorter overall survival. Univariate analysis of the clinicopathological factors revealed that only the grade of lymph node dissection (sufficient/insufficient) was associated with postoperative cancer death (odds ratio 2.993, 95% confidence interval 1.216-7.368, p = 0.017).Kaplan-Meier analysis and log-rank test revealed that the group with insufficient lymph node dissection had a higher incidence of postoperative cancer death than the group with sufficient dissection (p < 0.001).

CONCLUSIONS

Insufficient lymph node dissection is an independent risk factor for postoperative cancer death in patients who undergo surgery for stage II CRC.

Esophageal fibrovascular polyp removed by cervical esophagotomy

We report a case of esophageal fibrovascular polyp (FVP) removed by cervical esophagotomy. The patient was a 74-year-old man in whom an intraesophageal mass was detected by a chest CT examination during a complete medical check-up. An upper gastrointestinal series showed a large, pedunculated, cervical esophageal mass for which our preoperative diagnosis was a FVP. We studied its features, as well as removal procedures in 45 patients in the literature. Most patients had marked symptoms, but ours had no complaints, and so this case may be a rare one. Various removal procedures were reported, but thoracotomy and esophagectomy are considered to be the inappropriate procedures since FVP is a benign disorder.

Serum factors that suppress cytotoxic effect of methotrexate

AIM

To study the phenomenon that human erythroid leukemia K-562 cells are more sensitive to cytotoxic effect of antimetabolites when cultured in a serum-free medium than in a conventional medium containing fetal calf serum (FCS).

METHODS

Cytotoxic effects of methotrexate, azaserine and 5-fluorouracil were estimated by accessing the lactate dehydrogenase (LDH) activity of viable tumor cells. Proteins of FCS were separated using two-dimensional electrophoresis followed by mass spectrometry analysis.

RESULTS

Addition of 10% FCS attenuated anti-tumor activity of methotrexate and azaserine against K-562 cells compared with serum-free medium. Such an activity of FCS was different for each serum lot. Comparison of the proteins in active serum lot with those in not active one using two-dimensional electrophoresis showed that in the active serum there were proteins 150 kDa, which were absent in the not active serum lot. Mass spectrometry indicated that all those proteins had the amino acid sequence of albumin. Sera of one healthy volunteer and two patients with thyroid cancer also attenuated the activity of the agent.

CONCLUSION

Several lots of FCS and human serum demonstrated the ability to attenuate the cytotoxic effect of methotrexate in vitro, possibly due to the formation of albumin dimers/MTX complexes.

In vivo anti-tumor activities of gelatin

AIM

As reported previously, porcine skin gelatin exerted direct anti-tumor effect in vitro and induced anti-tumor peritoneal macrophages in vitro. The present study investigated whether or not the gelatin exerted anti-tumor effect in vivo.

METHODS

In vitro anti-tumor activities of peritoneal macrophages and the gelatin were evaluated with tritium thymidine uptake by target tumor cells. In vivo anti-tumor activity was evaluated with the survival of tumor-bearing animals and the size of the tumor.

RESULTS

Intraperitoneal daily administration of 12.5 mg of the gelatin prolonged the survival of mice which had been intraperitoneally inoculated with MH134 (hepatic cell carcinoma cell line) or Colon 26 (colon carcinoma cell line) tumor cells, and there were no tumors in case of MH134 cells inoculation. Intraperitoneal daily administration of 12.5 mg of the gelatin did not affect growth of subcutaneous MH134 tumor. The gelatin administered subcutaneously did not affect the survival of mice with intraperitoneal MH134 tumor. On the other hand, bovine skin gelatin administered subcutaneously achieved statistically significant prolongation of the survival. The contact of MH134 cells with porcine skin gelatin for 5 min was required for the gelatin to exert its anti-tumor activity in vitro. Porcine skin gelatin of 12.5 mg injected intraperitoneally was detected as protein in the peritoneal cavity 5 min after the injection. Peritoneal macrophages elicited by intraperitoneal injection with porcine skin gelatin suppressed tritium thymidine uptake by MH134 cells more strongly than those elicited by thioglycollate injection.

CONCLUSION

Porcine skin gelatin administered intraperitoneally prolonged the survival of tumor-bearing mice via activation of peritoneal macrophages and involvement of direct anti-tumor activity of porcine skin gelatin. Key Words: porcine skin, gelatin, dissemination.

Influence of inflammation-based prognostic score on mortality of patients undergoing chemotherapy for far advanced or recurrent unresectable colorectal cancer

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Background: Recent studies have revealed that the Glasgow prognostic score (GPS), an inflammation-based prognostic score that includes only C-reactive protein (CRP) and albumin, is a useful tool for predicting postoperative outcome in cancer patients. However, few studies have investigated the GPS in patients undergoing chemotherapy for far advanced or recurrent unresectable colorectal cancer (AR-UCRC). Objective: To demonstrate the influence of the GPS for prognostication of patients undergoing chemotherapy for AR-UCRC. Methods: The GPS was calculated as follows: patients with both an elevated level of CRP (>1.0 mg/dl) and hypoalbuminemia (<3.5 g/dl) were allocated a score of 2, and patients showing one or none of these blood chemistry abnormalities were allocated a score of 1 or 0, respectively. Results: One hundred twelve patients who had undergone chemotherapy for AR-UCRC with regimens such as such as FOLFIRI (5-fluorouracil [5-FU]/l-leucovorin [LV]/irinotecan hydrochloride [CPT-11]) or FOLFOX (5-FU/LV/oxialiplatin [L-OHP]) were evaluated retrospectively. Kaplan-Meier analysis and log rank test revealed that GPS2 predicted a higher risk of mortality than GPS0 or 1 (P <0.0001). Univariate analyses revealed that the neutrophil ratio (P = 0.0411), CA19–9 (P = 0.0473), CRP (P = 0.0477), albumin (P = 0.0043) and GPS (0,1/2) (P < 0.0001) were associated with mortality. Multivariate analyses using these five factors revealed that only GPS (0,1/2) (odds ratio, 6.071; 95% C.I., 1.625–22.68; P = 0.0073) was an independent risk factor of mortality. Conclusions: GPS is considered the most important and independent predictor of mortality in patients undergoing chemotherapy for AR-UCRC.

No significant financial relationships to disclose.

Comparison between treatment of kitchen-sink wastewater and a mixture of kitchen-sink and washing-machine wastewaters

In this paper, a submerged membrane bioreactor was used to treat 'higher-load' grey water: (a) kitchen-sink wastewater only, and (b) a mixture of kitchen-sink wastewater and washing-machine wastewater. For each type of wastewater, three systems operated at different hydraulic retention times (HRTs) were investigated. In the mixture of kitchen-sink wastewater and washing-machine wastewater, the reactor with a short HRT of four hours was stopped due to foaming. It has been observed that for both types of wastewater, an HRT of eight hours or longer can be used for the treatment. However, it has been observed that a higher COD in the permeate of the mixture can be obtained compared with that of the kitchen-sink wastewater only. This indicated that washing-machine wastewater has some component that is not easily biodegradable. The total linear akylbenzene sulfonate (LAS) removal was > 99% even at a concentration of 10-23 mg 1(-1).

Anti-tumor activity of murine peritoneal macrophages induced by porcine skin gelatin

AIM

To study the induction of anti-tumor activity of murine peritoneal macrophages in vitro by porcine skin gelatin.

METHODS

Anti-tumor activity of the macrophages was evaluated with tritium thymidine uptake by target tumor cells. ELISA was used to measure amounts of cytokines secreted in culture medium.

RESULTS

The ability of the gelatin to induce anti-tumor activity of the macrophages was stronger than that of lipopolysaccharide of E. coli. Combination of the lipopolysaccharide and interferon-gamma synergistically stimulated the macrophages but that of the gelatin and interferon-gamma additionally did. The culture supernatant of the macrophages incubated with the gelatin also showed higher anti-tumor activity than that with the lipopolysaccharide though the lipopolysaccharide was more excellent than the gelatin in stimulating secretion of anti-tumor cytokines (IL-1, IL-6, TNF-alpha, IFN-gamma) by the macrophages. Anti-TNF-alpha antibody partially suppressed the anti-tumor activity of the culture supernatant of the macrophages incubated with the lipopolysaccharide but not with the gelatin. The gelatin induced anti-tumor activity of the macrophages of C3H/HeJ as well as C3H/HeN mice whereas the lipopolysaccharide did only in C3H/HeN mice. The macrophages stimulated in vitro by the gelatin exerted anti-tumor activity in vivo. Moreover, the gelatin stimulated peritoneal exudates cells in vivo when subcutaneously administered with them.

CONCLUSIONS

Porcine skin gelatin induces anti-tumor activity of macrophages in mice and its magnitude is greater than that of lipopolysaccharide of E. coli. Its mechanism is different from that of the lipopolysaccharide but not fully clarified.

Clinical assessment of oral malodor intensity expressed as absolute value using an electronic nose

OBJECTIVES

In our previous study, scores determined via a multiple linear regression method (EN-MLR) involving an electronic nose provided objective halitosis-related measurements; however, this model afforded only relative expression exclusively. The objective of this investigation was to assess clinically oral malodor intensity expressed as an absolute value using an electronic nose.

SUBJECTS AND METHODS

Sixty-six subjects were evaluated based on results of an actual organoleptic test (OLT), measurements of volatile sulfur compound (VSC) concentrations, a score representing malodor intensity (EN-MI) as the absolute value and EN-MLR measured with an electronic nose system. Oral health parameters were also examined.

RESULTS

The OLT score served as a benchmark. The area under the receiver-operating characteristic (ROC) plots of EN-MI score (0.975) was significantly larger than that of log VSC (0.896) (P = 0.036); however, the area did not differ significantly from that of EN-MLR score (0.932). Percentage of teeth with pocket depth greater than or equal to 4 mm, tongue coating score and plaque control record displayed meaningful association with EN-MI score in multiple logistic regression analyses.

CONCLUSION

Oral malodor intensity expressed as an absolute value employing an electronic nose may be a suitable method for clinical evaluation of oral malodor.

Evaluation of islet transplantation from non-heart beating donors

We evaluated islet transplantation from non-heart beating donors (NHBDs) with our Kyoto Islet Isolation Method. All patients had positive C-peptide after transplantation. The average HbA(1C) levels of the five recipients significantly improved from 7.8 +/- 0.4% at transplant to 5.2 +/- 0.2% currently (p < 0.01). Three patients with no or a single autoantibody became insulin independent while the other two patients with double autoantibodies reduced their insulin requirement but did not become insulin independent. C-peptide in patients who became insulin-independent gradually increased after each transplantation whereas C-peptide in patients who did not become insulin-independent from 3 months after the first transplantation to the next transplantation dramatically decreased. The beta-score of the three patients who became insulin independent was the best of eight. In conclusion, our method makes it feasible to use NHBDs for islet transplant into type 1 diabetic patients efficiently.

A new technique for endoscopic submucosal dissection for early gastric cancer using an external grasping forceps

BACKGROUND AND STUDY AIMS

Endoscopic submucosal dissection (ESD) for early gastric cancer (EGC) has improved the success rate of en-bloc resection. We report here on a new technique using an external grasping forceps.

PATIENTS AND METHODS

A total of 25 patients with suitable EGCs over 10 mm in diameter located in the gastric body were enrolled. After submucosal injection followed by circumcision of the lesion with a needle-knife, an external grasping forceps was introduced with the help of a second grasping forceps and anchored at the distal margin of the lesion. With gentle oral traction applied with this forceps, the lesion was dissected endoscopically in retroversion from the aboral side.

RESULTS

The mean lesion size was 15.0 mm (range 10 - 25 mm). Using the technique described, all lesions could be resected en bloc with free margins. The mean procedure time was 45 min (range 30 - 80 minutes). No significant bleeding requiring blood transfusion or perforation occurred.

CONCLUSIONS

This technical modification may simplify and shorten the gastric ESD procedure, except for lesions in distal locations, without compromising the efficacy.