[Thoracic surgery in patients with autoimmune diseases]

Autoimmune diseases arise from an inappropriate immune response against substances and tissues normally present in the body. Although the pathogenesis are still unclear, several autoimmune diseases, such as dermatomyositis, systemic sclerosis, have a higher incidence of thoracic neoplasm. Also in the mediastinum several autoimmune diseases are known to associate thymoma. While the manifestations of the disease diverse, administration of immunosuppressant are commonly used for the management of aberrant immune response. Immunosuppressive therapies likely to increase susceptibility to infections and associate other side-effects, which could increase the risk of surgery and complicate the perioperative management. In this article we discuss the autoimmune diseases which are known to associate with thoracic and mediastinal neoplasms, and the perioperative management of thoracic surgery in patients with autoimmune diseases.

Results of a national survey on laparoscopic bariatric surgery in Japan, 2000-2009

INTRODUCTION

In Japan, laparoscopic bariatric surgery has not been popular until recently because morbidly obese patients were infrequently encountered previous and Japanese health insurance does not cover this type of surgery. In 2010, the Japan Research Society for Endoscopic and Laparoscopic Treatments of Obesity undertook the first nationwide survey on laparoscopic bariatric surgery to evaluate its current status and outcomes.

METHODS

A mail survey was sent to the society's 64 member institutions, which included almost all institutions in Japan actively performing laparoscopic gastrointestinal surgery.

RESULTS

From 2000 to 2009, 340 laparoscopic bariatric procedures, in total, were performed in nine of the 64 institutions (14%). The most popular procedure was laparoscopic Roux-en-Y gastric bypass (LRYGB, n=147), second was laparoscopic sleeve gastrectomy (LSG, n=102), and third was laparoscopic adjustable gastric banding (LAGB, n=55). However, the number of LRYGB procedures has decreased while the number of LSG procedures has rapidly increased. Total morbidity rates were 12.2% for LRYGB, 10.9% for LAGB, and 7.8% for LSG. Percent excess weight loss was 78% at 5 years after LRYGB, 52% at 4 years after LAGB, and 68% at 2 years after LSG. Although the bariatric procedures frequently resolved or improved obesity-related comorbidities, LRYGB appears to be superior to LAGB, as was previously reported.

CONCLUSION

The first nationwide survey of laparoscopic bariatric surgery in Japan clearly showed the current status and outcomes of this group of procedures. The Japanese results appear to be comparable to similarly undertaken surveys in Europe and the USA.

True Atomic Resolution Imaging on Semiconductor Surfaces with Noncontact Atomic Force Microscopy

The constant vibration mode and the constant excitation mode in noncontact atomic force microscopy were compared to investigate the force interaction between tip and surface. As a result, we found that the constant excitation mode is much more gentle than the constant vibration mode. We also succeeded in atomic resolution imaging on InP(110) surface not only in the noncontact region but in the contact region for the first time. Furthermore, we found the discontinuity of the force gradient curve on reactive Si(111)7×7 reconstructed surface. We proposed a model to explain the discontinuity with the crossover between the physical and chemical bonding interaction.

Remote access laparoscopic (REAL) surgery: a novel approach for single-port surgery without a visible scar

INTRODUCTION

Single-port laparoscopic surgery usually uses the transumbilical approach. However, the transumbilical incision may be associated with a high frequency of wound-related complications, including trocar site hernia and infection. Therefore, we developed remote access laparoscopic (REAL) surgery, a new access technique for single-port surgery within the pubic hairline. This study reports on a technique developed at our institution and describes our preliminary results.

MATERIALS AND SURGICAL TECHNIQUE

Ten patients with cholecystolithiasis underwent REAL surgery. A single 2.5-cm transverse incision was made medially within the pubic hairline area, and a SILS Port was inserted. A 5-mm flexible endoscope and an articulating grasper or a long laparoscopic grasper were used. Dissection of the gallbladder was achieved with laparoscopic ultrasonic shears just as in the conventional laparoscopic cholecystectomy. All procedures were successfully performed without conversion to conventional laparoscopic technique. There were no postoperative complications, and outpatient evaluation showed a clean scar within the pubic hair area in all patients.

DISCUSSION

Our early experience shows that REAL surgery is feasible and safe. This novel access technique can preserve the native umbilicus and provides an invisible scar that is concealed within the pubic hair.

Comparison of the prevalence of chronic kidney disease in Japanese patients with Type 1 and Type 2 diabetes

AIMS

The relationship between type of diabetes and risk of chronic kidney disease has not been studied in detail. We conducted this study to determine the prevalence of chronic kidney disease in Japanese adults with diabetes, with a particular emphasis on the comparison of Type 1 and Type 2 diabetes.

METHODS

We studied 3,575 Japanese patients with diabetes, 504 with Type 1 (mean +/- SD age 38 +/- 13 years; 350 women and 154 men) and 3071 with Type 2 diabetes (60 +/- 13 years; 1187 women and 1884 men). Prevalence rates of albuminuria [urinary albumin/creatinine ratio (> or = 30 mg/g], decreased estimated glomerular filtration rate (eGFR < 60 ml/min/1.73 m(2)) and chronic kidney disease (defined as albuminuria and/or decreased eGFR) were compared between the two diabetic groups.

RESULTS

The prevalence of albuminuria was higher in Type 2 than Type 1 diabetic patients by both Fisher's exact test (36.1 vs. 15.9%, P < 0.001) and multivariate logistic regression analysis [adjusted odds ratio (OR) = 1.482, 95% confidence interval (CI) = 1.050-2.091, P = 0.025]. The prevalence of decreased eGFR was also higher in Type 2 diabetic patients (25.2 vs. 7.9%, P < 0.001); however, the statistical significance disappeared after adjusting for covariates, including age (OR = 0.656, 95% CI = 0.395-1.088, P = 0.102). The prevalence of chronic kidney disease was also higher in Type 2 diabetic patients (46.0 vs. 19.1%, P < 0.001); however, the statistical significance disappeared in the multivariate analysis. CONCLUSIONS Type 2 diabetic patients are more than twice as likely as Type 1 diabetic patients to have chronic kidney disease due to an age-independent higher prevalence of albuminuria and age-dependent decreased eGFR.

Two-Dimensional Optimization of a Stent for an Aneurysm

This work attempts to optimize stents that are implanted at the neck of coronary or cerebral aneurysms to effect a flow diversion. A two-dimensional version of the stent, which is a series of struts and gaps placed at the neck, is considered as the first step. Optimization is carried out based on the principles of exploration of design space using reductions in velocity and vorticity in the aneurysm dome as the objective functions. Latin hypercube sampling first develops 30–60 samples of a strut-gap arrangement. Flow past an aneurysm with each of these samples is computed using the commercial software FLUENT and the objective functions evaluated. This is followed by a Kriging procedure that identifies the nondominated solutions to the system, which are the optimized candidates. Three different cases of stents with rectangular or circular struts are considered. It is found that placing struts in the proximal region of the neck gives the best flow diversion.

Serum folate and homocysteine and depressive symptoms among Japanese men and women

BACKGROUND/OBJECTIVES

Folate and homocysteine have been implicated to have a role in depression. However, results of epidemiologic studies on this issue have been inconsistent. The objective of this study was to clarify the association between serum folate and homocysteine concentrations and depressive symptoms in Japanese adults.

SUBJECTS/METHODS

We analyzed cross-sectional data for 530 municipal employees (313 men and 217 women), aged 21-67 years, who participated in a health survey at the time of periodic checkup. Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression (CES-D) scale. Logistic regression analysis was used to estimate odds ratios of depressive symptoms (CES-D scale scores of >or=16) with adjustment for potential confounding variables.

RESULTS

In total, 113 men (36.1%) and 79 women (36.4%) had depressive symptoms. A higher serum folate was associated with a decreased prevalence of depressive symptoms in men. The multivariate-adjusted odds ratios (95% confidence interval) of depressive symptoms for the lowest to highest quartiles of serum folate were 1.00 (reference), 0.53 (0.27-1.03), 0.33 (0.16-0.68) and 0.51 (0.25-1.03), respectively (trend P=0.03). Furthermore, the data suggested a positive association between serum homocysteine and depressive symptoms in men (trend P=0.06). In women, neither folate nor homocysteine was associated with depressive symptoms.

CONCLUSIONS

Low serum folate may be related to an increased prevalence of depressive symptoms in Japanese men.

The purinergic receptor P2Y, G-protein coupled, 2 (P2RY2) gene associated with essential hypertension in Japanese men

P2RY2 has an important function in the regulation of blood pressure by activating adenosine triphosphate (ATP). The aim of this study was to investigate the association between the human P2RY2 gene and essential hypertension (EH) through a haplotype-based case-control study that included two gender groups. The 273 EH patients and 255 age-matched controls were genotyped for five single-nucleotide polymorphisms (SNPs) of the human P2RY2 gene (rs4944831, rs1783596, rs4944832, rs4382936 and rs10898909). Data were analysed for men and women separately and then as a combined total group. For the total and the men only groups, the genotype distribution of the T allele of rs4944831 and the recessive model (GG vs TG+TT) of rs4944831 differed significantly between the EH patients and controls (P=0.028 and 0.019; P=0.009 and 0.008, respectively). Logistic regression showed that for the total and men groups, the TG+TT genotype of rs4944831 was more prevalent in EH patients than in the controls (P=0.026 and 0.011, respectively). For men, the overall distribution of the haplotype (SNP2-SNP4-SNP5) was significantly different between the EH patients and the controls (P=0.006). As compared with controls, the frequency of the T-A-G haplotype was significantly higher, whereas the T-C-G haplotype was significantly lower for the EH patients (P=0.001 and 0.014, respectively). In conclusion, the present results indicate that rs4944831 and the T-A-G haplotype of the human P2RY2 gene might be genetic markers for EH in Japanese men.

Methodologies to assess blood flow in cerebral aneurysms: current state of research and perspectives

With intracranial aneurysms disease bringing a weakened arterial wall segment to initiate, grow and potentially rupture an aneurysm, current understanding of vessel wall biology perceives the disease to follow the path of a dynamic evolution and increasingly recognizes blood flow as being one of the main stakeholders driving the process. Although currently mostly morphological information is used to decide on whether or not to treat a yet unruptured aneurysm, among other factors, knowledge of blood flow parameters may provide an advanced understanding of the mechanisms leading to further aneurismal growth and potential rupture. Flow patterns, velocities, pressure and their derived quantifications, such as shear and vorticity, are today accessible by direct measurements or can be calculated through computation. This paper reviews and puts into perspective current experimental methodologies and numerical approaches available for such purposes. In our view, the combination of current medical imaging standards, numerical simulation methods and endovascular treatment methods allow for thinking that flow conditions govern more than any other factor fate and treatment in cerebral aneurysms. Approaching aneurysms from this perspective improves understanding, and while requiring a personalized aneurysm management by flow assessment and flow correction, if indicated.

Cutaneous accumulation of abnormal polyglutamine proteins of patients with dentatorubral-pallidoluysian atrophy

BACKGROUND AND PURPOSE

Dentatorubral-pallidoluysian atrophy (DRPLA) is a hereditary spinocerebellar degeneration caused by expansion of a trinucleotide CAG repeat encoding a polyglutamine tract in a disease protein atrophin-1. The clinical features include ataxia, choreoathetosis, and dementia, which result from neural degeneration caused by the mutant atrophin-1.

METHODS

We performed skin biopsy in two patients with DRPLA.

RESULTS

We found multiple clear cells in the epidermis, which were positive for proteins containing an expanded polyglutamine stretches. The clear cells were p63 (+), S-100 (-), and cytokeratin 20 (-), showing that they were keratinocytes. Negative or weak signals of pan-cytokeratin were consistent with the finding of decreased tonofilaments at the electron microscopic level.

CONCLUSIONS

The presence of clear keratincoytes showed that the mutant proteins interfered in cellular functions not only in neural cells but also in keratinocytes. The skin is accessible by biopsy, making it important in the diagnosis. Furthermore, the polyglutamine staining in the skin may be useful for evaluation of therapeutic modalities for DRPLA and other polyglutamine diseases.

A new rapid and sensitive detection method for cereulide-producing Bacillus cereus using a cycleave real-time PCR

AIMS

To develop a rapid and sensitive detection method for cereulide-producing Bacillus cereus using a real-time PCR based on the sequence of the cereulide synthesis gene.

METHODS AND RESULTS

A total of 56 cereulide-producing B. cereus and 15 cereulide-negative strains were tested. We designed specific primers and probes for the detection of cereulide-producing B. cereus. The new cycleave real-time PCR assay gave positive detections for all of 56 cereulide-producing B. cereus strains, whereas all other strains including 10 systemic infectious disease strains were negative. No cross-reaction was observed and the internal control showed positive for all samples.

CONCLUSIONS

The performance of the assay was highly reproducible and specific for cereulide-producing B. cereus. The positive detection was obtained within only 2 h for cereulide-producing strains. The detection limit of this assay was evaluated as 10(4) CFU g(-1) food sample. The assay also confirmed that strains from systemic infectious cases were cereulide-negative.

SIGNIFICANCE AND IMPACT OF THE STUDY

This assay is applicable for contaminated foods as well as specimens from infectious disease cases. We recommend this assay for routine examination of suspected B. cereus food poisonings.

[Outcomes of bronchoplasty procedures for lung cancer]

A sleeve lobectomy is an established general thoracic surgical procedure. To improve clinical outcomes following the procedure, we reviewed the records of 60 patients who underwent a bronchoplasty procedure in our department from 1992 to 2007. Induction chemotherapy was performed for 20, of whom 10 underwent radiotherapy as well. For all subjects, the postoperative mortality and morbidity rates were 1.7% and 33.3%, respectively. Induction therapy did not significantly affect those rates, though complications related to bronchial anastomoses occurred exclusively in subjects who received that therapy. The overall 5-year survival rate was 51.0%, while subjects with pN0 (67.9%) and pN1 (60.0%) disease, and those in stage I (79.1%) and stage II (59.9%) had better survival as compared with patients with pN2 (16.9%) disease, and those in stage III (21.8%) and stage IV (0%). Furthermore, the survival rate of yp-stage I and II patients was significantly greater than that of those in yp-stage III and IV (59.9% vs. 14.3%, p = 0.0158). We concluded that patients in stages I, II or with pN0-1 disease are good candidates for a bronchoplasty procedure, though induction therapy should be considered thereafter. In addition, due diligence for postoperative complications is necessary.

[Full-thickness pleural biopsy using an Insulation-tipped Diathermic Knife in a patient with malignant pleural mesothelioma]

A 72-year-old woman was pointed out a right pleural effusion and thickening pleura on the chest computed tomography. The patient underwent semiflexible thoracoscopy under local anesthesia at the endoscopy room. The patient was placed in the lateral decubitus position, and flexible trocar was inserted with the single puncture technique. At the macroscopic findings, the parietal pleura were thickened prominently, and patchy plaques were occasionally recognized. A standard biopsy forceps hardly grasped pleura because of presence of scar, so we performed pleural biopsy using Insulation-tipped Diathermic (IT) knife. A subpleural injection of saline containing 0.5% lidokine and 0.005% epinephrine was performed for raising the affected parietal pleura with an injection needle. After a pin hole was made, the pleural lesion was incised in a circle by manipulating the IT knife, and the incised pleura were removed. Pathology revealed extensive fibrosis and epithelial mesothelioma by the specimen. This biopsy technique using IT knife through semiflexible thoracoscopy enabled to obtain a full-thickness pleura It is thought to be useful for the diagnosis of malignant pleural mesothelioma (MPM) in which standard forceps are difficult to grasp.

Reproducibility of haemodynamical simulations in a subject-specific stented aneurysm model--a report on the Virtual Intracranial Stenting Challenge 2007

This paper presents the results of the Virtual Intracranial Stenting Challenge (VISC) 2007, an international initiative whose aim was to establish the reproducibility of state-of-the-art haemodynamical simulation techniques in subject-specific stented models of intracranial aneurysms (IAs). IAs are pathological dilatations of the cerebral artery walls, which are associated with high mortality and morbidity rates due to subarachnoid haemorrhage following rupture. The deployment of a stent as flow diverter has recently been indicated as a promising treatment option, which has the potential to protect the aneurysm by reducing the action of haemodynamical forces and facilitating aneurysm thrombosis. The direct assessment of changes in aneurysm haemodynamics after stent deployment is hampered by limitations in existing imaging techniques and currently requires resorting to numerical simulations. Numerical simulations also have the potential to assist in the personalized selection of an optimal stent design prior to intervention. However, from the current literature it is difficult to assess the level of technological advancement and the reproducibility of haemodynamical predictions in stented patient-specific models. The VISC 2007 initiative engaged in the development of a multicentre-controlled benchmark to analyse differences induced by diverse grid generation and computational fluid dynamics (CFD) technologies. The challenge also represented an opportunity to provide a survey of available technologies currently adopted by international teams from both academic and industrial institutions for constructing computational models of stented aneurysms. The results demonstrate the ability of current strategies in consistently quantifying the performance of three commercial intracranial stents, and contribute to reinforce the confidence in haemodynamical simulation, thus taking a step forward towards the introduction of simulation tools to support diagnostics and interventional planning.

Impact of stent design on intra-aneurysmal flow. A computer simulation study

SUMMARY

In addition to providing a skeleton for vessel reconstruction, stent implantation as used for cerebral aneurysm treatment can induce flow redirection, thus reducing vortical flow velocities within the aneurysm cavity. Further, stent characteristics such as strut size, porosity and cell shape influence the changes in intra-aneurysmal flow by analog simulations. The purpose of this computer simulation study was to visualize the flow pattern over the entire neck area of a side wall aneurysm while changing the stent parameters. A 3-D computer model aneurysm was constructed to have a parent artery of 5 mm diameter and an aneurysm of 10 mm diameter. The distance between the midline of main artery and center point of the aneurysm was 6.8 mm, providing a neck length of 5 mm, a width of 3.6 mm, and a neck area of 14 mm 2. The simulations were carried out with a Finite Element Method based flow simulation package. The incompressible Navier-Stokes equation was solved for a steady flow with a mean speed of 290 mm/s, steady viscosity of 3.83 cp, and density of 1.0 g/cm3. Two parallel stent struts (dimensions: 100 mum m 100 mum m 2.0 mm) were introduced into the plane of the aneurysm neck. The fraction of the aneurysm neck cross-section occupied by the stent was 2.83% in all cases. The velocity distribution through the neck of the aneurysm was calculated for three different choices of separation between the struts for each of two orientations of the struts (parallel and perpendicular) relative to the vessel axis. The flow pattern in the aneurysm was composed of an inflow zone at the distal neck and of an outflow zone at the proximal neck. The placement of stent struts at the aneurysm neck resulted in a decrease in the mean speed in the aneurysm. The degree of reduction and the distribution of flow through the neck did depend on the orientation of the stent struts. The struts, when placed parallel or perpendicular to the parent vessel axis affected the mean speed through the aneurysm neck differently.

Studies on Design Optimization of Coronary Stents

The stent design itself seems to be one of the factors responsible for restenosis. As a remedy, the present work attempts to perform a design optimization of coronary stents from a hemodynamic point of view. For the purpose, we have applied the principles of modern exploration of design space restricting ourselves to two-dimensional considerations. Width, thickness, and spacing of the struts of the stent formed the design variables. The objectives chosen for optimization were the vorticity generated, length of recirculation zone, and the reattachment distance in between the struts. Both semicircular and rectangular cross sections of stents were included. Starting with the range of design variables, sample stent cases were generated using Latin hypercube sampling. Objective functions were calculated for each of these by computing the two-dimensional flow using software FLUENT under the assumption of a steady, Newtonian flow considering a model stent with three struts. This was followed by Kriging to construct a response surface, which gives the relationship between the objectives and the design variables. The procedure gave nondominated fronts, which consist of optimized designs. Stents with minimum vorticity, with minimum recirculation distance, and the ones with maximum reattachment length in between struts were generated. The procedure is capable of producing the optimum set of design variables to achieve the prescribed objectives.

Prognosis of patients with intrahepatic recurrence after hepatic resection for hepatocellular carcinoma: a retrospective study

AIMS

Hepatic resection is the most effective therapy for hepatocellular carcinoma (HCC); however, intrahepatic recurrence is common. Predictors of survival after intrahepatic recurrence have not been fully investigated. To clarify the prognosis and choice of treatment of intrahepatic recurrence after hepatic resection, we conducted a comparative retrospective analysis of 147 patients with HCC who underwent hepatic resection.

METHODS

We retrospectively examined the relations between clinicopathologic factors, including the number of recurrent intrahepatic tumors and long-term prognosis after recurrence in 147 HCC patients who underwent resection. We also examined long-term survival after recurrence based on treatment types and recurrence pattern.

RESULTS

Patients with multiple tumors (n=83) showed less tumor differentiation, more frequent portal invasion, a higher alpha-fetoprotein level, and larger tumors than did patients with solitary tumor (n=64). In the solitary tumor group, local ablation therapy and repeat hepatic resection were performed in 25 and 10, respectively. In the multiple tumor group, 59 were treated by transarterial chemoembolization. Multivariate analysis showed intraoperative blood transfusion and multiple tumors to be independent risk factors for poor cancer-related survival after recurrence. By subset analysis based on treatment types and recurrence pattern, survival after recurrence was significantly better in patients treated by local ablation therapy than those treated by other therapies in both solitary and multiple tumor groups.

CONCLUSIONS

For patients with solitary recurrence, a good prognosis is predicted. Local ablation therapy is a best candidate for treatment of solitary and multiple intrahepatic recurrences after hepatic resection.

Peripheral nerve regeneration through the space formed by a chitosan gel sponge

The clinical treatment of traumatized peripheral nerves often requires grafting of autologous cutaneous nerves. However, there are drawbacks in sacrificing healthy nerves and tissue scarring. In this study, an artificial material, freeze-dried chitosan gel sponge, was examined as a scaffold for nerve regeneration in rats. An 8-mm gap was made by removing a segment of the sciatic nerve, and the distal and proximal stumps were sandwiched by chitosan gel sponge. Rats were killed at 4, 7, 14, and 28 days, and 2 and 4 months after the operation and histological and morphometric evaluations were performed. Regenerating axons were observed at 4 days after the operation. Regenerating nerves extended the distal stump at 14 days after surgery. By electron microscopy, numerous macrophages appeared to phagocyte chitosan, and made a dense cell layer on the chitosan. Regenerating axons did not touch the chitosan, and extended through the space surrounded by macrophage-stacked chitosan. Regenerating nerves were well-myelinated 2 months after surgery. Regenerating nerves were on average 2.45 and 2.75 microm in diameter at 2 and 4 months, respectively, after surgery. These results indicate that the chitosan gel sponge sandwich might be suitable as a graft for peripheral nerve regeneration.

Clinical and experimental features of MuSK antibody positive MG in Japan

We investigated the presence of antibodies (Abs) against muscle-specific tyrosine kinase (MuSK) in Japanese myasthenia gravis (MG) patients. MuSK Abs were found in 23 (27%) of 85 generalized seronegative MG (SNMG) patients but not in any of the ocular MG patients. MuSK Ab-positive patients were characterized as having female dominance (M:F, 5:18), age range at onset 18 to 72 (median 45) years old, and prominent oculobulbar symptoms (100%) with neck (57%) or respiratory (35%) muscle weakness. Limb muscle weakness was comparatively less severe (52%), thymoma absent. Most patients had good responses to simple plasma exchange and steroid therapy. MuSK IgG from all 18 patients was exclusively the IgG 4 subclass and bound mainly with the MuSK Ig 1-2 domain. Serial studies of 12 individuals showed a close correlation between the variation in MuSK Ab titers and MG clinical severity (P = 0.01 by Kruskal-Wallis). MuSK Ab titers were sharply decreased in patients who had a good response to early steroid therapy or simple plasma exchange, but there was no change, or a rapid increase on exacerbation after thymectomy. Measurement of MuSK Ab titers aids in the diagnosis of MG and the monitoring of clinical courses after treatment.

Metabolic syndrome is not associated with markers of subclinical atherosclerosis, serum adiponectin and endogenous androgen concentrations in Japanese men with Type 2 diabetes

AIMS

Metabolic syndrome is characterized by its association with certain cardiovascular disease risk factors. The aim of this study was to investigate the relationships between metabolic syndrome and markers of subclinical atherosclerosis, serum adiponectin and endogenous androgen concentrations in Japanese men with Type 2 diabetes.

METHODS

Using the 2005 International Diabetes Federation (IDF) definition, we assessed the prevalence of the metabolic syndrome in 424 consecutive men with Type 2 diabetes aged 40-75 years in a cross-sectional study. We compared characteristics including ultrasonographic carotid atherosclerosis markers, pulse-wave velocity (PWV), and serum adiponectin, free testosterone, and dehydroepiandrosterone sulphate (DHEA-S) concentrations in diabetic patients with and without the metabolic syndrome.

RESULTS

The prevalence of the metabolic syndrome in Japanese men with Type 2 diabetes was 46.9%. Men with the metabolic syndrome had higher urinary albumin excretion rate than those without. Carotid intima-media thickness (0.97 +/- 0.26 vs. 0.91 +/- 0.18 mm), plaque score [3.3 (1.5-8.1) vs. 3.8 (1.3-6.2)], PWV (1818 +/- 331 vs. 1749 +/- 331 cm/s) and ankle-brachial index (1.10 +/- 0.14 vs. 1.08 +/- 0.16) did not differ significantly between patients with and without the metabolic syndrome. Similarly, serum adiponectin [3.70 (2.06-6.09) vs. 4.65 (3.09-7.02) microg/ml], free testosterone (36.4 +/- 10.7 vs. 34.7 +/- 11.1 pmol/l), and DHEA-S concentrations (3.29 +/- 1.83 vs. 3.17 +/- 1.63 micromol/l) did not differ significantly between groups,

CONCLUSIONS

The metabolic syndrome, as defined by the IDF, is not significantly associated with subclinical atherosclerosis markers, serum adiponectin, or endogenous androgen concentrations in Japanese men with Type 2 diabetes.

Recent advances in the surgical treatment for esophageal cancer in Japan: An experience of 1000 cases who underwent an esophagectomy at a single institute

15011

Background: Most cases of esophageal cancer are squamous cell carcinoma in Japan and the prognosis of such patients tends to be poor. However, the clinical results after an esophagectomy have recently been reported to improve. Methods: The mortality and morbidity as well as the patients’ prognosis were evaluated in 1000 cases of esophageal cancer who all underwent an esophagectomy in the Department of Surgery and Science (Department of Surgery II), Kyushu University, Japan from 1964 to 2006. The incidence of squamous cell carcinoma was 94 %. The patients were divided into three groups according to the operation period: Group I (n=197), Group II (n=432), and Group III (n=371) underwent an esophagectomy during the periods of ‘64-’80, ’81-’93, and ’93-’06, respectively. The incidences of TNM Stage 0 or I gradually increased (4, 19 and 24 %, respectively), while those of Stage IV decreased (28, 19 and 14 %). Results: The 5-yr overall survival rates (OSR) and cause-specific survival rate (CSR) after an esophagectomy for all 1000 cases were 30 and 37 %, respectively. The 5-yr OSRs of Groups I, II and III were 14, 27 and 46 %, while the 5-yr CSRs were 18, 36, and 52 %, respectively (P<0.01 between each group). When the prognoses were compared for each TNM stage, an improvement in the prognosis was observed at every tumor stage. A multivariate analysis (Cox proportional hazard model) revealed not only the age, depth of invasion, node metastasis, curability (each P<0.001) and extent of a lymphadenectomy (P<0.05) but also the operation period (P<0.001) to be independent prognostic factors. The morbidity rates of Groups I, II and III were 62, 38, and 33 %, and the incidences of pulmonary complications were 42, 13 and 14 %, respectively (P<0.01, Group I vs. II and I vs. III). The 30-day mortality rates were 8.1, 2.1 and 0 %, respectively (P<0.01 between each group). Conclusions: An analysis of a total of 1000 cases with esophageal cancer revealed that an esophagectomy has generally been safely performed without any critical pulmonary complications, while an increasingly favorable prognosis has been achieved due to recent advances in surgical techniques and treatment modalities.

No significant financial relationships to disclose.

Why did the gender difference influence survival in patients with completely resected stage I adenocarcinoma of the lung?

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Background: This study evaluates the influence of gender on survival and tumor recurrence in patients with completely resected stage IA and IB adenocarcinoma of the lung based on the analysis of the Japan Lung Cancer Research Group trial, which was a randomized prospective study of adjuvant chemotherapy with uracil-tegaful for stage I pulmonary adenocarcinoma. Methods: Patients were randomized to receive either oral uracil-tegaful (250 mg of tegaful/m2/day) for 2 years postoperatively or no adjuvant treatment. Survival was calculated from randomization until death. Survival estimated using the Kaplan-Meier method, and difference in survival between two groups was compares with the log-rank test. Results: The 5-year survival rate was 88.9% for the 502 women and 84.3% for the 477 men (median follow-up 72 months, p=0.0066). The relative risk of death for men vs women was 0.658 (95% C.I., 0.476–0.910, p=0.011), although the mean age of men was significantly less than that of women (p=0.041). There was no interaction between the gender differences and the efficacy of uracil-tegaful (p=0.657). However men presented with significantly more preoperative complications, more T2 diseases (p=0.0006), less non-papillary growth for histology (p=0.0078), less well differentiated subtype (p<0.001), higher serum carcinoembryonic antigen (CEA) level (p=0.004), and more smoking history than women (p<0.0001). Disease recurrence patterns were similar between the genders. The postoperative mortality showed a tendency to go up in men. Conclusions: Although longer life expectancy for women in Japan may in part explain, gender influences survival after complete resection for stage IA-B lung adenocarcinoma. The reasons for prolonged survival of women with this disease may be related to the several differences in the distribution of preoperative complications, smoking history and tumor biological behaviors such as T descriptor, histologic subtype, and serum CEA level. However cause- specific mortality was difficult to be explained. Further molecular epidemiologic and molecular profiling studies regarding gender as a prognostic and predictive factor for survival should be done.

No significant financial relationships to disclose.

Phase I/II study of S-1 combined with triweekly irinotecan for advanced or recurrent colorectal cancer

14541

Background: A dose-escalation study of irinotecan (CPT-11) combined with S-1, an oral dihydropyrimidine dehydrogenase inhibitory fluoropyrimidine, was performed to determine the maximum-tolerated dose (MTD), recommended dose (RD), dose-limiting toxicities (DLTs), and objective response rate (RR) in advanced or recurrent colorectal cancer. Methods: The subjects were untreated patients with inoperable advanced or recurrent colorectal cancer aged 20–75 years. S-1 was administered orally at 80 mg m-2 day-1 from day 1 to 14 of a 21-day cycle and CPT-11 was given intravenously on day 1 at an initial dose of 80 mg m-2 day-1, stepping up to 150 mg m-2. The treatment was repeated every 3 weeks, unless disease progression was observed. Results: In the phase I portion, only one of six patients at level 1 (80 mg m-2 of CPT-11) developed DLT, grade 3 diarrhea. No other serious adverse reactions occurred (either hematological or non- hematological), and all patients at levels 2 (100 mg m-2) to 5 (150 mg m-2) could receive therapy safely on an outpatient basis. The final RD was determined to be 150 mg m-2. In the phase II portion, fourteen patients including three patients in the final RD phase I portion were evaluated. The median treatment course was six (range: 2–17). The incidences of severe (grade 3–4) haematological and nonhaematological toxicities were 41.7 and 8.3%, respectively, but all were manageable. The RR was 50% (7 of 14, 95%CI: 23.0–77.0%), and Disease Control Rate (PR + SD) was seen in 71.4%. MST is not reached. Conclusions: Our phase I/II trial showed that S-1 combined with CPT-11 achieved a high response rate and could be given safely on an outpatient basis. These findings suggest that the therapy has potential as first- line treatment for inoperable advanced recurrent colorectal cancer. The updated analysis will be presented at the meeting.

No significant financial relationships to disclose.

Antitumor effects of the MIG and IP-10 genes transferred with poly [D,L-2,4-diaminobutyric acid] on murine neuroblastoma

The number of tumor-infiltrating lymphocytes is known to be related to outcomes in patients with a variety of malignancies. Interferon (IFN) gamma-inducible protein-10 (IP-10) and monokine induced by IFNgamma (MIG) have chemotactic effects on activated T lymphocytes and natural killer (NK) cells. The aim of this study was to evaluate the antitumor effects of exogenous expression of the MIG and IP-10 genes delivered to solid tumors by poly [D,L-2,4-diaminobutyric acid] (PDBA). The murine MIG and IP-10 genes were transfected into mouse neuroblastoma cells with PDBA. MIG and IP-10 levels in supernatants of transfected cells were measured by enzyme-linked immunosorbent assay. The chemotactic activities of MIG and IP-10 in the supernatants of cell cultures were measured by chemotaxis assay. Tumors were injected in vivo with PDBA/pmMIGColon, two colonsIP-10 complexes to evaluate the effects of these genes on tumor volume and survival time of mice. Transfected PDBA/pmMIGColon, two colonsIP-10 complexes produced MIG and IP-10 protein in vitro. MIG and IP-10 proteins secreted into the culture medium showed chemotactic activity. MIG and IP-10 gene therapy with the PDBA system in vivo significantly inhibited tumor growth and prolonged survival time of mice. In conclusion, PDBA-mediated MIG and IP-10 gene therapy may be useful for treatment of solid tumors.

Prognosis and postoperative lymphocyte count in patients with hepatocellular carcinoma who received intraoperative allogenic blood transfusion: a retrospective study

AIMS

The effect of perioperative blood transfusion on the survival of hepatocellular carcinoma (HCC) has not been fully investigated. To clarify the prognostic value of intraoperative allogenic blood transfusion, we conducted a comparative retrospective analysis of 224 patients with HCC who underwent hepatic resection.

METHODS

We compared clinicopathologic background and survival after hepatic resection between patients who received intraoperative blood transfusion (n=101) and those who did not (n=123).

RESULTS

Patients with blood transfusion had a larger tumor and more frequent vascular invasion than those without blood transfusion. The 5-year cancer-related survival rate after hepatic resection, but not the disease-free survival rate, was significantly lower in patients who underwent blood transfusion than in those who did not (38.3% vs. 66.7%, P<0.01). Multivariate analysis showed intraoperative blood transfusion (P=0.02), microscopic portal invasion (P<0.01), and preoperative serum alpha-fetoprotein elevation (P=0.03) to be independent risk factors for poor outcome after hepatic resection. The negative effect of blood transfusion on postoperative survival was observed only in patients with a tumor larger than 50mm in diameter. The absolute peripheral blood lymphocyte count on postoperative day 1 was significantly lower in patients who underwent blood transfusion (880/mm(3)) than in those who did not (1081/mm(3)) (P<0.01).

CONCLUSIONS

Our data suggest that intraoperative blood transfusion results in immunosuppression in the early postoperative period, allowing for progression of residual HCC after resection. Therefore, intraoperative allogenic blood transfusion should be avoided in patients with resectable HCC, particularly in those with a large tumor.

Measurement of elastic properties of blood vessels

This paper is related to the measurements of the modulus of elasticity of an artery by studying the deformations due to the inflation of an angioplasty balloon catheter used for Interventional Radiology (IR) procedures. Various types of balloons are studied in order to characterize and compare their behaviors at the time of inflation. A test bench, consisting of an angioplasty balloon, a Polyvinyl alcohol model and an actuator used to inflate a balloon, is developed for the realization of the experiments. The pressure-volume curve during the inflation of a balloon is observed. Elasticity modulus are derived with an analytical model of the measurement system. The results are then analyzed and compared to existing data from literature.

Measurement of internal constraints during an interventional radiology procedure

This paper presents a novel method for measurements of internal constraints during an Interventional Radiology procedure. Fiber-optic strain gauge, operating as a Fabry-Perot interferometer, is inserted and navigated inside a polyvinyl alcohol (PVA) model. The information obtained from deformation of the Fabry-Perot cavity is analyzed and the results are then rescaled through a calibration procedure for catheters. The measures help to locate the maximum interaction forces between catheter and blood vessel wall at approximately 1.3 N and to observe the shape of dynamic interaction during manipulation.