Clinical significance of incidental colonic 18F-FDG uptake on PET/CT images in patients with gastric adenocarcinoma

BACKGROUND AND OBJECTIVES

We assessed the ability of positron emission tomography-computed tomography (PET/CT) to detect synchronous colonic pathology and determined the significance of 18F-fluorodeoxyglucose (18F-FDG) activity in the colon of gastric cancer patients.

METHODS

A total of 239 gastric cancer patients who underwent PET/CT and colonoscopy preoperatively were included. FDG uptake patterns on PET/CT were classified as (1) group A, focal; (2) group B, diffuse; and (3) group C, no uptake. The PET/CT findings were compared with the results of concurrent colonoscopy.

RESULTS

In group A, a total of 123 polyps of >0 mm were observed. Of these, nine polyps were colonic adenocarcinomas and six were high-grade dysplasia. The incidence of colonic adenocarcinomas was significantly higher in group A than in the other two groups (p = 0.037). There was a significant correlation between SUVmax values and incidence of colonic polyps of >10 mm (r = 0.471, p = 0.04). The distribution pattern of SUVmax in polyps with adenoma (>10 mm) was less homogenous than in polyps (>10 mm) with adenocarcinoma.

CONCLUSIONS

The focal colonic FDG uptake in PET/CT requires colonoscopic confirmation. The suspicion of colonic malignancy increased in the presence of polyps >10 mm that showed a positive correlation with the SUVmax.

Decoherence window and electron-nuclear cross relaxation in the molecular magnet V15

Rabi oscillations in the V(15) single molecule magnet embedded in the surfactant (CH(3))(2)[CH(3)(CH(2))(16)CH(2)](2)N(+) have been studied at different microwave powers. An intense damping peak is observed when the Rabi frequency Ω(R) falls in the vicinity of the Larmor frequency of protons ω(N). The experiments are interpreted by a model showing that the damping (or Rabi) time τ(R) is directly associated with decoherence caused by electron-nuclear cross relaxation in the rotating reference frame. This decoherence induces energy dissipation in the range ω(N) - σ(e) < Ω(R) < ω(N), where σ(e) is the mean superhyperfine field induced by protons at V(15). Weaker decoherence without dissipation takes place outside this window. Specific estimations suggest that this rapid cross relaxation in a resonant microwave field, observed for the first time in V(15), should also take place, e.g., in Fe(8) and Mn(12).

Increased metastases are associated with inflammation and matrix metalloproteinase-9 activity at incision sites in a murine model of peritoneal dissemination of colorectal cancer

BACKGROUND

Pro-inflammatory processes associated with the early postoperative state are known to contribute to peritoneal metastases in patients with advanced diseases. This study aimed to determine whether the wound healing response after an abdominal incision leads to increased matrix metalloproteinase (MMP)-9 activity locally, contributing to peritoneal metastasis.

MATERIALS AND METHODS

Metastatic tumors were initiated in C57bl/6J male mice (8wk of age) using a peritoneal injection model with syngeneic MC38 murine colon cancer cells; appropriate control mice also were studied. Injections were performed into the peritoneum in the right lower quadrant. We then observed the occurrence and rate of peritoneal metastasis for each group.

RESULTS

By making an incision into the abdominal wall of mice, an inflammatory response was induced at the wound site. The inflammatory response initiated by the wound, in turn, increased the proliferation of mesothelial cells and increased inflammatory cell numbers locally, which contributed to an increase in parietal peritoneal metastases. In addition, the wound healing process increased the expression of pro-inflammatory cytokines and the number of inflammatory cells in the peritoneum. Moreover, MMP-9 in the modeled postoperative injury setting increased the number and severity of peritoneal metastases.

CONCLUSIONS

Thus, we conclude that wound-associated inflammation enhances pro-MMP-9 expression, which plays a key role in the growth and progression of cancer cells associated with peritoneal metastases.

Morbidity and mortality after non-curative gastrectomy for gastric cancer in elderly patients

BACKGROUND AND OBJECTIVES

This study examined the surgical outcome of non-curative resection in elderly patients with gastric cancer.

METHODS

The study reviewed 278 patients who underwent non-curative resection for advanced gastric cancer. The clinicopathological features of elderly patients (≥ 75 years, n = 257) and younger patients (<75 years, n = 21) were compared.

RESULTS

Although no difference was observed in terms of preoperative performance, there were distinct differences in terms of albumin level, presence of symptoms, and the rate of comorbidities between the two groups. The postoperative morbidity and mortality rate did not differ between the two groups. Age, preoperative performance status, preoperative transfusion, and presence of comorbidity were not independent predictors of postoperative complications. However, the extent of gastric resection and combined resection were closely related to postoperative complications in patients with non-curative gastrectomy.

CONCLUSIONS

In a setting of non-curative resection for gastric cancer, age was not a limiting factor. Rather, the risk of postoperative morbidity should be considered carefully in total gastrectomy and combined resection.

Incidental colonic 18F-FDG uptake in gastric cancer patients: Correlation with colonoscopic and histopathologic findings

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Background: The ability of integrated positron emission tomography and computed axial tomography (PET-CT) to detect synchronous colonic pathology in gastric cancer patients is not fully defined.

Methods: Between Jan 2009 and July 2010, total 370 patients diagnosed as primary gastric cancer underwent curative resection in our institution. Among them 147 patients had taken PET-CT and colonoscopy preoperatively. The FDG uptake pattern were reviewed and classified as focal (showed foci of FDG uptake>3.5 SUV max), diffuse (showed FDG uptake<3.5 SUVmax without any foci of uptake) and absent uptake (showed no FDG uptake pattern). Patients with history of known colonic malignancy or colon surgery were excluded.

Results: Among the 18 patients who had discovered as focal incidental FDG uptake in colon without any previous colonic pathology, in six patients, has revealed unexpected colonic adenocarcinoma. The mean SUVmax value of focal uptake group(Group A) is 7.3 (±2.3), for those six patients, it was 9.4 (±2.9,p=0.02). And in the diffuse uptake group, most common colonic pathology was tubular adenoma with low grade dysplasia following hyperplastic polyp. The age, gender and primary gastric cancer stage was not differed between the groups.

Conclusions: In conclusion, the focal uptake pattern in colon on preoperative PET-CT in gastric cancer patients should be followed by colonoscopy evaluation for incidental significant colonic pathology even colon cancer. However, there was no cut off SUVmax value for the mandatory colonoscopy evaluation based on PET-CT.

Clinical significance of obesity index (VFA versus BMI) as a risk factor for gastric cancer surgery

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Background: Obesity is considered as a major perioperative risk factor in various cancer surgeries. We aimed to elucidate the effect of two different obesity index, such as VFA (visceral fat area) and BMI (body mass index), on gastrectomy.

Methods: From Mar 2009 to July 2010, 632 patients with diagnosed gastric carcinoma underwent curative gastrecomy at Seoul St. Mary’s hospital. We reviewed patients’ clinicopatholic data and collected 187 patients who had data including BMI, VFA and SFA. Patients with body mass index (BMI) ≥ 25 kg/m 2 were defined as obese and visceral fat area (VFA) ≥ 100 were defined as centrally obese.

Results: Out of a total 187 patients, eighty patients were in the high BMI group and 107 patients were in the low BMI group. We selected patients with high VFA and low BMI (group A) and compared to the patients with low VFA and low BMI (group B). Out of a total 107 patients in low BMI, seventy three patients were censored as high VFA, and age older than 60 and male patients were prevalent in this group (p=0.045 and 0.046). The operation time (OT) and estimated blood loss (EBL) were significantly higher in group A than group B (p=0.043 and p=0.05).

Conclusions: VFA and BMI are correlated each other and successfully represent patients’ obesity. However in selected patients, such as male patients with age older than sixty, VFA more practically represent their obesity.

Temperature-dependent Fermi surface evolution in heavy fermion CeIrIn5

We address theoretically the evolution of the heavy fermion Fermi surface (FS) as a function of temperature (T), using a first principles dynamical mean-field theory approach combined with density functional theory. We focus on the archetypical heavy electrons in CeIrIn{5}. Upon cooling, both the quantum oscillation frequencies and cyclotron masses show logarithmic scaling behavior [∼ln(T{0}/T)] with different characteristic temperatures T{0}=130 and 50 K, respectively. The enlargement of the electron FSs at low T is accompanied by topological changes around T=10-50  K. The resistivity coherence peak observed at T≃50  K is the result of the competition between the binding of incoherent 4f electrons to the spd conduction electrons at Fermi level (E{F}) and the formation of coherent 4f electrons.

Anisotropic Dirac fermions in a Bi square net of SrMnBi2

We report the observation of highly anisotropic Dirac fermions in a Bi square net of SrMnBi(2), based on a first-principles calculation, angle-resolved photoemission spectroscopy, and quantum oscillations for high-quality single crystals. We found that the Dirac dispersion is generally induced in the (SrBi)(+) layer containing a double-sized Bi square net. In contrast to the commonly observed isotropic Dirac cone, the Dirac cone in SrMnBi(2) is highly anisotropic with a large momentum-dependent disparity of Fermi velocities of ~8. These findings demonstrate that a Bi square net, a common building block of various layered pnictides, provides a new platform that hosts highly anisotropic Dirac fermions.

Negative impact of leakage on survival of patients undergoing curative resection for advanced gastric cancer

BACKGROUND AND OBJECTIVES

Leakage has been shown to adversely affect survival in patients undergoing surgery for gastrointestinal malignancies. However, the effect of leakage following radical gastrectomy in patients with gastric cancer remains unclear.

METHODS

In total, 478 patients with advanced gastric cancer who underwent surgery with curative intent were reviewed. Anastomosis or duodenal stump leakage was diagnosed clinically or radiologically. Risk factors for leakage were evaluated by univariate and multivariate analyses. The impact of leakage on patient survival was analyzed using the Kaplan-Meier method.

RESULTS

Leakage was diagnosed in 32 of 478 patients (6.7%); 14 patients (2.9%) exhibited esophagojejunal anastomotic leakage, 14 (2.9%) showed duodenal stump leakage, and four (0.8%) showed gastroduodenal anastomotic leakage. Poor performance status [odds ratio (OR): 4.01, 95% confidence interval (CI): 1.80-8.93] and tumor location (OR: 3.74, 95% CI: 1.56-8.89) were risk factors for postoperative leakage. Overall mean survival of patients with leakage was significantly lower than that of patients without leakage (30.5 vs. 96.2 months; P < 0.001). Leakage was one of the independent predictive factor for overall survival [hazard ratio (HR): 3.58, 95% CI: 2.29-5.59].

CONCLUSIONS

Postoperative inflammation due to leakage is a negative prognostic factor for patients with advanced gastric cancer.

Long-term outcomes and survival after laparoscopy-assisted distal gastrectomy for gastric cancer: three-year survival analysis of a single-center experience in Korea

BACKGROUND AND OBJECTIVES

Laparoscopy-assisted distal gastrectomy (LADG) has been established as an alternative treatment for early gastric cancer (EGC) because of excellent short-term results. However, only a few reports have considered the long-term outcomes of LADG. In this study, we investigated the 3-year outcome and survival of patients who underwent LADG.

METHODS

We assessed 182 patients with gastric adenocarcinoma who underwent LADG. The indication for LADG was confined to EGCs (T1N0 or T1N1 cases). The clinicopathological characteristics and long-term survival data of all patients were analyzed.

RESULTS

The overall morbidity and mortality rates of the patients were 11% and 0%, respectively. An analysis of the final pathological stages of the patients revealed that 160 had stage Ia, 20 had stage Ib, and only 2 had stage II. The median follow-up period was 44 months (range, 2-73 months), and there were two recurrences. Five patients died of other causes, but no patients died of a gastric cancer recurrence. The 3-year overall and disease-specific survival rates were 97.3% and 100%, respectively.

CONCLUSIONS

LADG for EGC is acceptable in terms of both short- and long-term outcomes. Thus, LADG can be considered a primary treatment for EGC.

Use of laparoscopy as an alternative to computed tomography (CT) and positron emission tomography (PET) scans for the detection of recurrence in patients with gastric cancer: a pilot study

BACKGROUND

This study aimed to evaluate laparoscopy as a diagnostic method for detecting recurrence in patients with advanced gastric cancer.

METHODS

Diagnostic laparoscopy was performed for 12 patients with insufficient evidence of intraabdominal gastric cancer recurrence by computed tomography or positron emission tomography. By comparing laparoscopic observations with conventional radiologic results, the diagnostic accuracy of laparoscopy was assessed.

RESULTS

In 11 (92%) of 12 cases of recurrence not diagnosed by imaging studies, laparoscopic examination confirmed the case as a recurrence. Using diagnostic laparoscopy, retroperitoneal lymph node recurrence was confirmed in two patients, peritoneal seeding nodules in five patients, and recurrent masses invading the mesocolon in two patients. Two patients had no definitive recurrence grossly but were confirmed as recurrence cases by washing cytology during the laparoscopic procedure. One patient had a duodenal stump recurrence. No patients experienced operation-related morbidity.

CONCLUSION

Laparoscopy is a safe and feasible method for detecting recurrence with acceptable accuracy. This approach provides more accurate information than conventional imaging methods.

Intragastric approach for submucosal tumors located near the Z-line: a hybrid laparoscopic and endoscopic technique

BACKGROUND

The present study was designed to evaluate the feasibility and impact of the "intragastric" approach to laparoscopic wedge resection as a surgical option for the treatment of suspected small sized gastric submucosal tumors (SMTs) located at the level of Z-line.

METHODS

We reviewed six patients who underwent laparoscopic intragastric resection of a suspected gastric SMT. In all cases, tumor mass was located just below the Z-line. The patients' clinicopathologic characteristics and surgical outcomes were prospectively recorded and reviewed.

RESULTS

All six patients were underwent successfully laparoscopic wedge resection by the intragastric approach using a balloon-type trocar. No case was required open conversion. The mean operation time was 128 min, and the mean hospital stay was 4 days. Five cases were proven to have leiomyoma, and one case was found to have gastrointestinal stromal tumor with low risk. The mean tumor size was 2.7 cm.

CONCLUSION

Laparoscopic resection through the "intragastric" approach is a safe and feasible option for gastric SMTs located at the level of Z-line.

Effect of early oral feeding after gastric cancer surgery: a result of randomized clinical trial

BACKGROUND

To date, early oral feeding after gastrectomy for gastric cancer has not been accepted universally. Therefore, we performed a randomized clinical trial to determine whether early oral feeding after curative surgery for gastric cancer can be tolerated and whether it has an effect on recovery.

METHODS

From July 2008 to February 2009, 58 patients were enrolled and 4 were excluded according to set criteria. The patients in the early feeding group began a liquid diet on the second postoperative day, and then were fed a soft diet from the third day until the day they were discharged. The patients in the control group began a liquid diet on the fourth day. The primary endpoint of this study was the duration of postoperative hospitalization.

RESULTS

No significant differences were found in the clinico-operative characteristics between the 2 groups. The duration of hospitalization (P = .044) and time until flatus (P = .036) in the early group were decreased significantly. With regard to the rates of morbidity, cost of hospitalization, postoperative symptoms, and pain scales, no significant differences were found. The quality of life scores were decreased significantly at the fatigue (P = .007) and nausea and vomiting (P = .048) immediately after operation in the early feeding group.

CONCLUSION

Early oral feeding after gastric cancer surgery is feasible and can result in shorter hospitalization and improvements in several aspects of quality of life in the early postoperative period.

Spin-orbit qubits of rare-earth-metal ions in axially symmetric crystal fields

Contrary to the well-known spin qubits, rare-earth-metal qubits are characterized by a strong influence of crystal field due to large spin-orbit coupling. At low temperature and in the presence of resonance microwaves, it is the magnetic moment of the crystal-field ground state which nutates (for several micros) and the Rabi frequency Omega(R) is anisotropic. Here, we present a study of the variations of Omega(R)(H(0)) with the magnitude and direction of the static magnetic field H(0) for the odd 167Er isotope in a single crystal CaWO(4):Er(3+). The hyperfine interactions split the Omega(R)(H(0)) curve into eight different curves which are fitted numerically and described analytically. These "spin-orbit qubits" should allow detailed studies of decoherence mechanisms which become relevant at high temperature and open new ways for qubit addressing using properly oriented magnetic fields.

Double contrast-enhanced MRI of viral hepatitis-induced cirrhosis: correlation of gross morphological signs with hepatic fibrosis

The purpose of this study was to evaluate the diagnostic ability of the expanded gallbladder fossa and right posterior hepatic notch signs for hepatic fibrosis determined by double contrast-enhanced MRI. For patients with chronic viral hepatitis B (n = 96) or hepatitis C (n = 13) who underwent gadopentate dimeglumine-enhanced dynamic MRI followed by ferucarbotran-enhanced gradient-echo imaging, the degree of parenchymal fibrosis was categorised into three groups based on the extent of reticulation and nodularity: (1) pre-cirrhotic or minimal fibrosis; (2) mild to moderate fibrosis; (3) advanced cirrhosis. Each group was evaluated for the presence of a sharp notch in the posterior-medial surface of the right lobe of the liver and expanded gallbladder fossa. The expanded gallbladder fossa sign gradually increased with an increasing degree of fibrosis (Group 1, 50%; Group 2, 61%; Group 3, 78%), and there was no significant difference (p>0.5) between hepatitis B (67%) and C (73%). In the case of the right posterior hepatic notch sign, only 6% of Group 1 and Group 2 patients were positive; 27% of hepatitis B patients and 90% of hepatitis C patients in Group 3 exhibited the sign (p<0.05). Owing to its low prevalence, even in advanced cirrhosis, the right posterior hepatic notch sign is of little value in the diagnosis of cirrhosis due to chronic hepatitis B virus infection, whereas an expanded gallbladder fossa could be used as a non-specific indicator of early fibrosis before the gross appearance of advanced hepatic fibrosis.

Laparoscopy-assisted distal gastrectomy for overweight patients in the Asian population

PURPOSE

It is generally considered difficult to operate on overweight patients, who are also at increased risk of postoperative complications. We conducted this study to clarify the technical feasibility and postoperative outcomes of laparoscopy-assisted distal gastrectomy (LADG) for early gastric cancer (EGC) in overweight patients.

METHODS

Between July 2004 and December 2006, 116 patients with preoperatively diagnosed EGC underwent LADG at our department. We classified these patients into two groups based on body mass index (BMI). There were 60 patients in the high-BMI (> or =23 kg/m2) group and 56 in the low-BMI (<23 kg/m2) group. The clinicopathologic features, postoperative outcomes, and operation-related morbidities were compared.

RESULTS

None of the patients needed conversion to laparotomy. There were no notable differences in clinical characteristics or histologic features between the groups. Although the operation time was significantly longer in the high-BMI group, there were no significant differences in postoperative bowel recovery, postoperative hospital stay, or operation-related morbidities.

CONCLUSIONS

Laparoscopy-assisted distal gastrectomy for overweight patients is feasible and safe; however, because of its technical difficulties and the complexities of lymph node dissection, it should be carefully considered, and may only be suitable for early-stage cancers.

Physicochemical properties, and antioxidant and antimicrobial effects of garlic and onion powder in fresh pork belly and loin during refrigerated storage

Pork loin and belly cuts were pumped to 110% of their original weight with solutions containing 5% of various ingredients (sodium ascorbate, garlic, and onion powder), and evaluated the physicochemical properties, and antioxidant and antimicrobial activities during refrigerated storage at 8 degrees C. The addition of garlic and onion powder tended to increase redness (a) and yellowness (b) in both the belly lean and loin with the exception of a few cases. Free fatty acid values in both pork belly and loin cuts were reduced with the addition of these ingredients, as compared to the control. Significant differences in peroxide values were observed in sodium ascorbate and garlic-injected belly, and in sodium ascorbate and onion-injected loin, as compared to the control. Thiobarbituric acid reactive substance values in the pork belly with garlic or onion powder were significantly lower than in the belly without these ingredients or with sodium ascorbate (P < 0.05). Total plate counts were lower in both the belly and loin containing garlic and onion powder, as compared to the control. In both the belly and loin cuts, the content of oxidative products (volatile compounds) was reduced with the addition of garlic and onion powder, particularly the aldehydes (hexanal). Overall, garlic and onion in enhanced meats showed an antioxidant activity as effective as that of sodium ascorbate and also an antimicrobial effect to inhibit the growth of total bacteria and Enterobacteriaceae.

[cDNA cloning and analysis of tissue-specific gene expression of rat urocortin II]

The corticotropin-releasing hormone (CRH) family of neuropeptides includes CRH (a 41 amino acid hypothalamic peptide) and urocortin. Corticotropin-releasing factor (CRF), a peptide first isolated from mammalian, plays an important role in the regulation of the pituitary-adrenal axis, and in endocrine, autonomic, immune and behavioral responses to stress. In this study we cloned rat urocortin II (UCNII) cDNA from rat mid-brain by RT-PCR. The rat UCNII clone contained an open reading frame (ORF) coding 109 amino acids which shared 90% and 63% homology with mouse and human homologues, respectively, The expression of UCN HII mRNA is mainly distributed in bone marrow, ovary, uterus, hypophysis, adrenal gland, and skin. In this study, rat recombinant UCN was expressed in E. coli and purified in active form. Furthermore, purified recombinant UCN II protein specifically binds to CRF receptor 2 in rat ROS 17/2.8 and GH3 cells by flow-cytometry analysis. UCN II cDNA clone obtained in this study will be useful for further investigation on behavioral responses to stress in rats.

Caspase-3 activation as a key factor for HBx-transformed cell death

OBJECTIVES

Nuclear factor-kappa B (NF-kappaB) activation has been associated with the tumorigenic growth of hepatitis B virus X protein (HBx)-transformed cells. This study was aimed to find a key target for treatment of HBx-mediated cancers.

MATERIALS AND METHODS

NF-kappaB activation, endoplasmic reticulum-stress (ER-stress), caspase-3 activation, and cell proliferation were evaluated after Chang/HBx cells permanently expressing HBx viral protein were treated with inhibitors of NF-kappaB, proteasome and DNA topoisomerase.

RESULTS

Inhibition of NF-kappaB transcriptional activity by transient transfection with mutant plasmids encoding Akt1 and glycogen synthase kinase-3beta (GSK-3beta), or by treatment with chemical inhibitors, wortmannin and LY294002, showed little effect on the survival of Chang/HBx cells. Furthermore, IkappaBalpha (S32/36A) mutant plasmid or other NF-kappaB inhibitors, 1-pyrrolidinecarbonidithioic acid and sulphasalazine, were also shown to have little effect on the cell proliferation. By contrast, proteasome inhibitor-1 (Pro1) and MG132 enhanced the HBx-induced ER-stress response and the subsequent activation of caspase-12, -9 and -3 and reduced cell proliferation. Camptothecin (CPT), however, triggered activation of caspase-3 without induction of caspase-12, and reduced cell proliferation. In addition, CPT-induced cell death was reversed by pre-treatment with z-DEVD, a caspase-3-specific inhibitor.

CONCLUSIONS

Detailed exploitation of the regulators of caspase-3 activation could open the gate for finding an efficient target for development of anticancer therapeutics against HBx-transformed hepatocellular carcinoma.

Dissipation behavior of lufenuron, benzoylphenylurea insecticide, in/on Chinese cabbage applied by foliar spraying under greenhouse conditions

Chinese cabbage has long been consumed as a staple food by the Koreans in various forms of fresh, salted, or fermented as kimchi. To fulfill the off-season demand for this crop, it has become a common practice to be cultivated under greenhouse conditions. Since pesticide residues in/on leafy vegetables have strongly concerned with food safety in the Korean society, the changes of lufenuron residues, in/on Chinese cabbage applied by foliar spraying under greenhouse conditions was investigated. Lufenuron 5% emulsifiable concentrate (EC) was sprayed with diluted solution of recommended and double doses to the crop. The shoots of the cabbage were harvested immediately after spraying, and sequentially the harvests were conveyed to analyze the residual amounts. The deposited level of the analyte in/on Chinese cabbage under greenhouse conditions seemed to be difficult to produce the crop with 0.2 ppm of maximum residue limit (MRL) of the Korea Food and Drug Administration (KFDA).

Screening of magnetic moments in PuAm alloy: local density approximation and dynamical mean field theory study

The puzzling absence of Pu magnetic moments in a PuAm environment is explored using the self-consistent dynamical mean field theory calculations in combination with the local density approximation. We argue that delta-Pu-Am alloys provide an ideal testbed for investigating the screening of moments from the single impurity limit to the dense limit. Several important effects can be studied: volume expansion, shift of the bare Pu on-site f energy level, and the reduction of the hybridization cloud resulting from the collective character of the Kondo effect in the Anderson lattice. These effects compensate each other and result in a coherence scale, which is independent of alloy composition, and is around 800 K.