Adult right living-donor liver transplantation with special reference to reconstruction of the middle hepatic vein

Two hundred fifty-three consecutive living-donor liver transplant recipients with a right liver graft (RLG) were divided into three groups: an extended right liver graft (ERLG) group (n = 47) in which the middle hepatic vein (MHV) trunk was included in the graft, a modified right liver graft (MRLG) group (n = 114) in which the MHV tributaries were reconstructed with cryopreserved homologous veins and a simple RLG group (n = 92) in which the MHV tributaries were sacrificed. The volume of the anterior sector was significantly impaired in the RLG group compared to the other two groups, whereas the volume of the posterior sector was significantly improved in the RLG group, indicating that the impaired anterior sector regeneration by MHV deprivation was compensated by the posterior sector regeneration. The regeneration rate of the anterior sector was highest in the ERLG group (92%), moderate in the MRLG group (71%) and lowest in the RLG group (52%). The whole graft regeneration rate of the ERLG group was significantly higher than that of the other two groups. Poor regeneration, however, was not correlated with delayed functional recovery or long-term outcome. Short-term, the patency of reconstructed MHV tributaries was over 90%, but occlusion occurred frequently over the long-term, especially in V5.

[Surgical treatment outcomes of multimodality therapy for locally recurrent rectal cancer]

The aim of this study was to clarify the status of multimodality therapy for locally recurrent rectal cancer. Between 2000 and 2012, 27 patients with locally recurrent rectal cancer underwent surgical resection. We examined 18 patients treated with preoperative chemo-radiotherapy (CRT group) and 9 patients treated with surgery alone (surgical group). The rate of R0 - resection was 89% in the CRT group and 78% in the surgical group. The mean operative durations for the CRT and surgical groups were 323 min and 289 min, respectively. The mean amount of bleeding was 1,462 g for the CRT group and 2,846 g for the surgical group. There was no significant difference in the rate of postoperative complications between both groups (CRT group: 78%, surgical group: 78%). Regarding local recurrences, the recurrence rate of the CRT group was 28%, whereas that of the surgical group was 67%. The 3-year and 5-year overall survival rates of the CRT group were 71%and 44%, respectively, whereas those of the surgical group were 58% and 22%, respectively. These results showed that CRT treatment was associated with an improvement in prognosis. Preoperative CRT and surgical resection should be the standard treatment for patients with local recurrence.

[A review of stereotactic radiotherapy (SRT) for lung metastasis of colon cancer]

We retrospectively analyzed the efficacy of stereotactic radiotherapy (SRT) for lung metastasis of colon cancer, with particular emphasis on local tumor control. Seven patients with 8 lesions underwent SRT for lung metastasis of colon cancer in our institution between February 2012 and February 2014. We judged the curative effect of SRT on the basis of tumor shrinkage observed on computed tomography (CT) scans. All lung metastases decreased in size, and local recurrence was not observed. SRT is a technique involving three-dimensional radiation, which decreases radiation exposure to neighboring normal tissues. The 2-year local tumor control rate for lung metastasis of colon cancer with SRT is 77.9%, and the 2-year survival rate is 53.7%. Our results, in which all patients achieved local control, suggest that SRT is a minimally aggressive treatment option for lung metastasis of colon cancer in cases where a pneumonectomy is difficult to perform. In the future, results from long-term studies are needed to validate our findings.

Inferolateral marginal orbitectomy: a simple adjuvant technique for orbital decompression

The number of patients with mild exophthalmos, without severe eye symptoms, who wish to undergo aesthetic orbital decompression, is increasing. Removal of the lateral and inferior orbital walls is a common procedure for mild to moderate exophthalmos. However, the limited space between the globe and the orbital wall is often troublesome for surgeons introducing surgical devices. As a result, the decompression tends to be insufficient in the posterior region of the orbit. We describe a simple adjuvant surgical technique to address this limitation. Through a laterally extended, transconjunctival approach, the inferior and lateral margins of the orbit are removed in a crescent shape before the actual decompression. This manoeuvre widens the working space and offers better visibility, enabling sufficient removal of the orbital walls. The technique presented facilitates the approach to the posterior regions of the orbit, enabling surgeons to more easily perform orbital decompression.

Surgical resection of peritoneal or thoracoabdominal wall implants from hepatocellular carcinoma

BACKGROUND

Peritoneal or thoracoabdominal wall implants from hepatocellular carcinoma (HCC) occur occasionally after biopsy, percutaneous therapy or resection, and spontaneously, with no effective treatment available. The objective of this study was to clarify the indications for, and benefits of, surgical resection of such HCC implants.

METHODS

This was a retrospective analysis of patients who underwent resection for peritoneal or chest wall implants from HCC over 14 years (1997-2011). Indications for surgery for implanted HCC were: limited number of implanted lesions including those found incidentally during surgery; intrahepatic lesion absent or predicted to be locally controllable; and absence of ascites with sufficient hepatic functional reserve. Prognostic factors affecting survival after resection were determined by univariable and multivariable analysis.

RESULTS

A total of 32 patients underwent 36 resections. Cumulative 1-, 3- and 5-year overall survival rates were 71, 44 and 39 per cent respectively, with a median survival time of 34.5 months. Univariable and multivariable analysis revealed that poor perioperative intrahepatic disease control was associated with poor survival.

CONCLUSION

Surgical resection of implanted HCC may improve long-term survival in selected patients as long as intrahepatic disease is absent or well controlled.

Impact of hospital volume on hospital mortality, length of stay and total costs after pancreaticoduodenectomy

BACKGROUND

High morbidity and mortality rates after pancreaticoduodenectomy (PD) have led to concentration of this surgery in high-volume centres, with improved outcomes. The extent to which better outcomes might be apparent in a healthcare system where the mortality rate is already low is unclear.

METHODS

The Japanese Diagnosis Procedure Combination database was used to identify patients undergoing PD between 2007 and 2010. Patient data included age, sex, co-morbidities at admission, type of hospital, type of PD, and the year in which the patient was treated. Hospital volume was defined as the number of PDs performed annually at each hospital, and categorized into quintiles: very low-, low-, medium-, high- and very high-volume groups. The Charlson co-morbidity index was calculated using the International Classification of Diseases, tenth revision, codes of co-morbidities.

RESULTS

A total of 10 652 patients who underwent PD in 848 hospitals were identified. The overall in-hospital mortality rate after PD was 3·3 per cent (350 of 10 652), and for the groups ranged from 5·0 per cent for the very low-volume group to 1·4 per cent for the very high-volume group (P < 0·001). Multivariable analysis revealed a significant linear relationship between higher hospital volume and shorter postoperative length of stay compared with the very low-volume group, and between increasing hospital volume and lower total costs.

CONCLUSION

A significant relationship exists between increasing hospital volume, lower in-hospital mortality, shorter length of stay and lower costs for patients undergoing PD in Japan. Centralization of PD in this healthcare system is therefore justified.

Long-term clinical and functional results of intersphincteric resection for lower rectal cancer

BACKGROUND

Intersphincteric resection (ISR) is an alternative to abdominoperineal resection (APR) for super-low rectal cancer. The aim of this study was to evaluate the long-term curability after ISR over an average 6-year observational period, to compare the postoperative functional outcomes for ISR with those for low anterior resection (LAR), and to determine whether ISR is a function-preserving surgery.

METHODS

Between 2000 and 2007, a total of 77 consecutive patients with low rectal cancer underwent curative ISR. The curability outcomes for ISR, LAR, and APR were compared. We evaluated the postoperative defecation functions, Wexner incontinence score (WIS), and defecation quality of life (QOL) for a between-groups comparison (ISR/LAR).

RESULTS

The 5-year survival rate after ISR was 76.4 %, and the outcome was better than for APR (APR 51.2 %, LAR 80.7 %). Local recurrence after ISR occurred in 7.8 % of patients (APR 12.1 %, LAR 11.7 %). The average daily frequency of defecation was 3.7 times for the ISR patients and 3.2 times for the LAR patients, indicating no significant difference between the groups. Moreover, there were no significant differences between the groups for defecation functions. The WIS was 8.1 for ISR and 4.9 for LAR, and the defecation QOL for ISR and LAR was not significantly different (modified fecal incontinence QOL score: ISR 34.3, LAR 26.5).

CONCLUSIONS

The long-term clinical and functional results suggest that ISR may be the optimal sphincter-preserving surgery for patients with lower rectal cancers who cannot be treated with a double-stapling technique.

Anti-factor IXa/X bispecific antibody (ACE910): hemostatic potency against ongoing bleeds in a hemophilia A model and the possibility of routine supplementation

BACKGROUND

We previously reported that a humanized anti-factor IXa/X bispecific antibody, hBS23, mimics the function of FVIII even in the presence of FVIII inhibitors, and has preventive hemostatic activity against bleeding in an animal model of acquired hemophilia A. After further molecular engineering of hBS23, we recently identified an improved humanized bispecific antibody, ACE910, for clinical investigation.

OBJECTIVES

To elucidate the in vivo hemostatic potency of ACE910 by examining its effect against ongoing bleeds, and to determine its pharmacokinetic parameters for discussion of its potency for prophylactic use.

METHODS

A non-human primate model of acquired hemophilia A was established by injecting anti-primate FVIII neutralizing antibody. When bleeds emerged following an artificial bleed-inducing procedure, either ACE910 or recombinant porcine FVIII (rpoFVIII) was intravenously administered. rpoFVIII was additionally administered twice daily on the following 2 days. Bleeding symptoms were monitored for 3 days. A pharmacokinetic study and multiple-dosing simulations of ACE910 were also performed.

RESULTS

A single bolus of 1 or 3 mg kg-1 ACE910 showed hemostatic activity comparable to that of 10 U kg-1 (twice daily) rpoFVIII against ongoing bleeds. The determined ACE910 pharmacokinetic parameters included a long half-life (3 weeks) and high subcutaneous bioavailability (nearly 100%). The simulation results based on pharmacokinetic parameters indicated that the above hemostatic level could be maintained with once-weekly subcutaneous administration of ACE910, suggesting the possibility of more effective prophylaxis.

CONCLUSIONS

ACE910 may offer an alternative on-demand treatment option for patients with hemophilia A, as well as user-friendly and aggressive routine supplementation.

Anti-factor IXa/X bispecific antibody (ACE910): hemostatic potency against ongoing bleeds in a hemophilia A model and the possibility of routine supplementation

BACKGROUND

We previously reported that a humanized anti-factor IXa/X bispecific antibody, hBS23, mimics the function of FVIII even in the presence of FVIII inhibitors, and has preventive hemostatic activity against bleeding in an animal model of acquired hemophilia A. After further molecular engineering of hBS23, we recently identified an improved humanized bispecific antibody, ACE910, for clinical investigation.

OBJECTIVES

To elucidate the in vivo hemostatic potency of ACE910 by examining its effect against ongoing bleeds, and to determine its pharmacokinetic parameters for discussion of its potency for prophylactic use.

METHODS

A nonhuman primate model of acquired hemophilia A was established by injecting anti-primate FVIII neutralizing antibody. When bleeds emerged following an artificial bleed-inducing procedure, either ACE910 or recombinant porcine FVIII (rpoFVIII) was intravenously administered. rpoFVIII was additionally administered twice daily on the following 2 days. Bleeding symptoms were monitored for 3 days. A pharmacokinetic study and multiple-dosing simulations of ACE910 were also performed.

RESULTS

A single bolus of 1 or 3 mg kg⁻¹ ACE910 showed hemostatic activity comparable to that of 10 U kg⁻¹ (twice daily) rpoFVIII against ongoing bleeds. The determined ACE910 pharmacokinetic parameters included a long half-life (3 weeks) and high subcutaneous bioavailability (nearly 100%). The simulation results based on pharmacokinetic parameters indicated that the above hemostatic level could be maintained with once-weekly subcutaneous administration of ACE910, suggesting the possibility of more effective prophylaxis.

CONCLUSIONS

ACE910 may offer an alternative on-demand treatment option for patients with hemophilia A, as well as user-friendly and aggressive routine supplementation.

Indocyanine green fluorescence imaging in the surgical management of liver cancers: current facts and future implications

Imaging detection of liver cancers and identification of the bile ducts during surgery, based on the fluorescence properties of indocyanine green, has recently been developed in liver surgery. The principle of this imaging technique relies on the intravenous administration of indocyanine green before surgery and the illumination of the surface of the liver by an infrared camera that simultaneously induces and collects the fluorescence. Detection by fluorescence is based on the contrast between the (fluorescent) tumoral or peri-tumoral tissues and the healthy (non-fluorescent) liver. Results suggest that indocyanine green fluorescence imaging is capable of identification of new liver cancers and enables the characterization of known hepatic lesions in real time during liver resection. The purpose of this paper is to present the fundamental principles of fluorescence imaging detection, to describe successively the practical and technical aspects of its use and the appearance of hepatic lesions in fluorescence, and to expose the diagnostic and therapeutic perspectives of this innovative imaging technique in liver surgery.

Controlling the window size in mesoporous SBA-16

Dotted line: constant mean curvature with Im3̄m symmetry. Solid surface: electron density map of calcined SBA-16.

An immunohistochemical study of matrix proteins in the craniofacial cartilage in midterm human fetuses

Immunohistochemical localization of collagen types I, II, and X, aggrecan, versican, dentin matrix protein (DMP)-1, martix extracellular phosphoprotein (MEPE) were performed for Meckel's cartilage, cranial base cartilage, and mandibular condylar cartilage in human midterm fetuses; staining patterns within the condylar cartilage were compared to those within other cartilaginous structures. Mandibular condylar cartilage contained aggrecan; it also had more type I collagen and a thicker hypertrophic cell layer than the other two types of cartilage; these three characteristics are similar to those of the secondary cartilage of rodents. MEPE immunoreactivity was first evident in the cartilage matrix of all types of cartilage in the human fetuses and in Meckel's cartilage of mice and rats. MEPE immunoreactivity was enhanced in the deep layer of the hypertrophic cell layer and in the cartilaginous core of the bone trabeculae in the primary spongiosa. These results indicated that MEPE is a component of cartilage matrix and may be involved in cartilage mineralization. DMP-1 immunoreactivity first became evident in human bone lacunae walls and canaliculi; this pattern of expression was comparable to the pattern seen in rodents. In addition, chondroid bone was evident in the mandibular (glenoid) fossa of the temporal bone, and it had aggrecan, collagen types I and X, MEPE, and DMP-1 immunoreactivity; these findings indicated that chondroid bone in this region has phenotypic expression indicative of both hypertrophic chondrocytes and osteocytes.

Intravenous thrombolysis for patients with reverse magnetic resonance angiography and diffusion-weighted imaging mismatch: SAMURAI and NCVC rt-PA Registries

BACKGROUND AND PURPOSE

The characteristics of reverse magnetic resonance angiography and diffusion-weighted imaging (MRA-DWI) mismatch (RMM), defined as a large DWI lesion in the absence of major artery occlusion (MAO), remain unknown, especially in patients treated with intravenous recombinant tissue plasminogen activator (rt-PA).

METHODS

Patients with stroke in the middle cerebral artery territory were included. Early ischaemic changes (EIC) were assessed with the Alberta Stroke Program Early CT Score on DWI (DWI-ASPECTS). All patients were divided into four groups based on the presence of MAO and a DWI-ASPECTS cut-off value of <7. RMM was defined as DWI-ASPECTS <7 without MAO. Clinical characteristics, symptomatic intracerebral hemorrhage (sICH) and favorable functional outcome (modified Rankin Scale score 0-2) at 90 days were compared amongst the four groups.

RESULTS

Of the 486 patients enrolled (167 women, median age 74 years, median initial National Institutes of Health Stroke Scale score 13), reverse MRA-DWI mismatch was observed in 24 (5%). Of the clinical characteristics, cardioembolism was the only factor that was independently associated with RMM [odds ratio (OR) 5.49, 95% confidence interval (CI) 1.25-24.1]. Multivariable analyses revealed that patients with RMM more commonly had sICH than those with DWI-ASPECTS ≥ 7 irrespective of the presence (OR 5.44, 95% CI 1.13-26.1) or absence (13.1, 2.07-83.3) of MAO, and they had a more favorable functional outcome than those with DWI-ASPECTS < 7 plus MAO (7.45, 2.39-23.2).

CONCLUSION

RMM was observed in 5% of patients treated with rt-PA and associated with cardioembolism. Patients with RMM may benefit from thrombolysis compared with those with EIC with MAO, although increment in the rate of sICH is a concern.

[Conversion therapy for synchronous colorectal liver metastases]

Conversion therapy, a treatment strategy that facilitates the conversion of unresectable colorectal liver metastases (CRLM) to resectable CLRM after chemotherapy, has been reported to be effective. We assessed the applicability of treatment strategies for conversion therapy in 93 patients with synchronous CRLM encountered at our department. Of the 93 patients, 12 underwent conversion therapy and there was no significant difference in the clinicopathological factors of CRLM. The first-line regimen for 67% of the 12 patients who underwent conversion therapy was multidrug therapy with oxaliplatin and the number of courses administered ranged from 3 to 24. The 5-year survival rate of patients who underwent conversion therapy was 46%,and there was no significant difference when compared with the 5-year survival rate of patients who underwent hepatectomy for resectable CRLM. In order to improve the survival rate of patients with synchronous CRLM, it is important that more patients undergo conversion therapy with effective chemotherapy. Moreover, we believe that it is necessary to assess the appropriate balance in treatment between chemotherapy and hepatectomy in the future.

[Ten cases of locally advanced rectal cancer that were treated with preoperative chemotherapy with S-1 plus oxaliplatin]

The purpose of this study was to evaluate S-1 plus oxaliplatin( SOX) as neoadjuvant chemotherapy for the treatment of patients with locally advanced rectal cancer. The clinical features and management of 10 patients with this disease seen at the Hirosaki University Hospital between 2011 and 2013 were examined. Of these patients, 30% were treated with bevacizumab, and the mean number of courses was 3.3. There were no adverse events of severity greater than Grade 3, and no patient required treatment interruption because of toxicity. SOX administered every 3 weeks was associated with a partial response rate of 40% and a tumor control rate of 100%; progressive disease was not observed. Curative resection was performed in all patients except in 1 with liver metastasis. With regard to the pathological findings, 2 cases were of Grade 0; 4 cases, of Grade 1a; and 2 cases, of Grade 2. Postoperative complications such as anastomotic leakage were observed in 80% of the patients. Thus, SOX administration without a central venous drug injection port was very useful because most patients could receive SOX treatment on an outpatient basis. However, the frequency of postoperative complications associated with this treatment is increasing, and therefore, it is important to accumulate more evidence.

[Surgical outcomes and prognostic factors of primary colorectal cancer with peritoneal dissemination]

We evaluated the surgical outcomes and prognostic factors of primary colorectal cancer with peritoneal dissemination. Between 1990 and 2012, a total of 81 cases of operated primary colorectal cancer with peritoneal dissemination were reviewed. According to the classification by the degree of peritoneal dissemination, the 3-year overall survival rate of patients with P1, P2, and P3 were 22%, 14%, and 16%, respectively. A significant difference was not observed between these 3 groups. According to the degree of surgical curability, the 1-year and 3-year overall survival rates of the patients with curability B were 75% and 30%, respectively. The overall survival rate of patients with curability B was higher than those of curability C (p< 0.01). Multivariate analysis showed that the curability of operation (p=0.03) and the existence of hepatic metastases (p=0.01) were significant prognostic factors affecting overall survival. The median relapse-free survival time of patients with curability B was 7.8 months. Nevertheless, long-term survivor cases existed in this group. These findings suggest that complete resection of the primary tumor and metastatic lesions is important to prolong survival term.

[Prognostic risk factors associated with recurrence after curative resection in patients with stage II colorectal cancer]

The aim of this study was to clarify the risk factors associated with recurrence in patients with stage II colorectal cancer.

METHOD

We performed a retrospective analysis of 316 patients with stage II colorectal cancer who underwent gross radical colectomy between 1994 and 2003.

RESULTS

The overall recurrence rate was 10.8%. Univariate analysis identified 5 risk factors associated with recurrence: depth of tumor invasion (tumor penetration of the serosa[SE]-tumor invasion of adjacent structure[s SI]), lymphatic invasion( ly2-3), venous invasion( v2-3), budding( grade 2-3), and perineural invasion (PN1). Multivariate analysis identified 3 risk factors associated with recurrence: budding (grade 2-3; p=0.008), depth of tumor invasion( SE-SI; p=0.008), and venous invasion( v2-3; p=0.034).

CONCLUSION

The results of this study suggest that active postoperative adjuvant chemotherapy should be considered for the treatment of patients with stage II colorectal cancer with budding( grade 2-3), venous invasion( v2-3), or tumor depth of SE or SI.

Influence of preoperative docetaxel, cisplatin, and 5-fluorouracil on the incidence of complications after esophagectomy for resectable advanced esophageal cancer

A limited number of patients with resectable advanced esophageal cancer can be cured by surgery alone. Although a regimen that consists of docetaxel, cisplatin, and 5-fluorouracil (DCF) is a potential preoperative chemotherapy (PCT) option for squamous cell carcinoma of the esophagus, the influence of DCF on subsequent esophagectomies remains unclear. A total of 80 patients who received preoperative DCF chemotherapy, and 174 patients who did not receive any preoperative treatment were retrospectively analyzed. There were no treatment-related deaths. No delays in surgery due to adverse events related to DCF were reported. Although patients who received PCT had significantly more advanced cancers and worse preoperative conditions, the incidence rates of complications did not increase. Although the frequency of severe complications was significantly higher in patients who received PCT, this treatment was not an independent factor for the occurrence of severe complications. PCT with DCF did not negatively affect subsequent esophagectomies with regard to the frequency of complications.

Proteomics-based identification of novel proteins in temporal tendons of patients with masticatory muscle tendon--aponeurosis hyperplasia

Masticatory muscle tendon-aponeurosis hyperplasia (MMTAH) is a new disease associated with limited mouth opening that is often misdiagnosed as a temporomandibular disorder; subsequently, patients are mistakenly treated with irreversible operations. Due to the poor presentation and characterization of symptoms, the underlying pathological conditions remain unclear. We have previously conducted a proteomic analysis of tendons derived from one MMTAH subject and one facial deformity subject using two-dimensional fluorescence difference gel electrophoresis and liquid chromatography coupled with tandem mass spectrometry. However, the results were obtained for only one subject. The aim of the present study was to confirm the expression of specific molecules in tendon tissues from multiple subjects with MMTAH by applying two-dimensional polyacrylamide gel electrophoresis with matrix-assisted laser desorption ionization time-of-flight mass spectrometry. Of the 19 proteins identified in tendons from both MMTAH and facial deformity patients, fibrinogen fragment D and beta-crystallin A4 were up-regulated, whereas myosin light chain 4 was down-regulated in MMTAH. We also found fibrinogen to be expressed robustly in tendon tissues of MMTAH patients. Our data provide the possibility that the distinctive expression of these novel proteins is associated with the pathology of MMTAH.

American Cocker Spaniel chronic hepatitis in Japan

BACKGROUND

American Cocker Spaniels are predisposed to chronic hepatitis.

OBJECTIVE

To describe the clinical and histological features of chronic hepatitis in Japanese American Cocker Spaniels.

ANIMALS

Thirteen cases examined from 2003 to 2009.

METHODS

Retrospective study. Medical records were searched for American Cocker Spaniels with chronic liver diseases. History, physical examination, clinicopathologic features, hepatic ultrasonographic findings, hepatic histopathology, and immunohistochemistry were evaluated.

RESULTS

The median age was 4.6 (1.9-10.7) years. Clinical signs included inappetence (11/13), ascites (11/13), lethargy (9/13), diarrhea (7/13), and melena (2/13). Only 1/13 dogs was jaundiced. Clinicopathological abnormalities were increased liver enzymes (gamma-glutamyl transpeptidase: 9/12, aspartate aminotransferase: 7/10, alanine aminotransferase: 6/13, alkaline phosphatase: 6/13), increased total serum bile acid concentrations (10/12), and hypoalbuminemia (10/13). The liver had an irregular surface in all dogs and acquired portosystemic collaterals were verified in 11/13 dogs by abdominal ultrasound (2), laparoscopy (4), or both (5). Liver histology revealed severe fibrosis and cirrhosis in all cases, subdivided in lobular dissecting hepatitis (7), periportal fibrosis (1), micronodular cirrhosis (3), and macronocular cirrhosis (2). Inflammatory activity was low to mild. Immunohistochemical stains showed ductular proliferation. The median survival time was 913 (range: 63-1981) days.

CONCLUSION AND CLINICAL IMPORTANCE

Hepatitis in Japanese American Cocker Spaniels is clinically silent until an advanced stage and is associated with severe hepatic fibrosis leading to cirrhosis, extensive ductular/putative hepatic progenitor cell proliferation, portal hypertension, and acquired portosystemic collateral shunting, but relatively long survival times. Lobular dissecting hepatitis seems more prevalent than in previously reported cases from other countries.

Methylation levels of LINE-1 in primary lesion and matched metastatic lesions of colorectal cancer

Background:

LINE-1 methylation level is a surrogate marker of global DNA methylation. LINE-1 methylation in primary colorectal cancers (CRCs) is highly variable and strongly associated with a poor prognosis. However, no study has examined LINE-1 methylation levels of metastatic CRCs in relation to prognosis or assessed the heterogeneity of LINE-1 methylation level within the primary CRCs.

Methods:

Pyrosequencing was used to quantify LINE-1 methylation level in 42 liver metastases, 26 matched primary tumours, and 6 matched lymph node (LN) metastases. KRAS, BRAF, and PIK3CA mutation status and microsatellite instability (MSI) status were also examined.

Results:

The distribution of LINE-1 methylation level in liver metastases was as follows: mean, 67.3; range, 37.1–90.1. Primary tumours showed LINE-1 methylation levels similar to those of matched liver and LN metastases. The difference in LINE-1 methylation level between superficial areas and invasive front areas was within 7.0 in all six cases evaluated. Prognostic impact of LINE-1 hypomethylation in liver metastases on overall survival was not observed. The concordance rate was 94% for KRAS, 100% for BRAF, 88% for PIK3CA, and 97% for MSI.

Conclusion:

Alteration of LINE-1 methylation level may occur in early CRC tumorigenesis, and the LINE-1 methylation level is relatively stable during CRC progression.

catena-Poly[[[bis-(4-pyridine-aldoxime-κN (1))zinc]-μ-benzene-1,4-dicarboxyl-ato-κ(2) O (1):O (4)] 4-pyridine-aldoxime monosolvate]

In the title compound, {[Zn(C₈H₄O₄)(C₆H₆N₂O)₂]·C₆H₆N₂O}_n, the Zn^II ion exhibits a tetra­hedral coordination environment defined by two benzene-1,4-dicarboxylate dianions and two 4-pyridinealdoxime ligands. The dianions bridge the Zn^II ions, giving a zigzag chain along the b axis. Adjacent chains are connected by O—H⋯O hydrogen bonds, forming a cavity in which an uncoordinating 4-pyridine­aldoxime mol­ecule is located; this mol­ecule is linked by O—H⋯O and O—H⋯N hydrogen bonds to the zigzag chain.

Left hepatic trisectionectomy for advanced perihilar cholangiocarcinoma

BACKGROUND

Data on outcomes of left hepatic trisectionectomy (LT) for perihilar cholangiocarcinoma are limited. The aim of this study was to clarify short- and long-term outcomes of LT for perihilar cholangiocarcinoma.

METHODS

Patients with perihilar cholangiocarcinoma who underwent LT between January 2000 and October 2011 were analysed. Surgical variables, mortality, morbidity (Clavien grade I-V), recurrence sites and survival were compared between subjects who underwent LT, right hemihepatectomy or left hemihepatectomy.

RESULTS

A total 214 patients underwent resection for perihilar cholangiocarcinoma, 25 (11·7 per cent) of whom underwent LT, 88 (41·1 per cent) right hemihepatectomy and 94 (43·9 per cent) left hepatectomy. There were no deaths among those who had LT, but 20 patients developed complications. The incidence of grade IIIa complications was significantly higher among patients who underwent LT than in patients who had right or left hemihepatectomy (P = 0·001 and P < 0·001 respectively). Only one patient developed a grade IIIb or IV complication (liver failure) after LT. The overall 5-year survival rate after LT was 39 per cent and median survival was 45 months. There were no significant differences in survival between patients who underwent LT and those who had a right or left hemihepatectomy.

CONCLUSION

LT may provide a good outcome for advanced perihilar cholangiocarcinoma.

Modeling of adhesion, protrusion, and contraction coordination for cell migration simulations

Cell migration is a highly complex, dynamical biological phenomenon that involves precise spatio-temporal coordination of distinctive sub-processes including adhesion, protrusion, and contraction of the cell. Observations of individual tumor cell migration reveal that cells generally exhibit either mesenchymal-type or amoeboid-type migration modes in native like environments. However, it has also been observed that some migrating cells are capable of morphologically adapting to their environment by modifying their type of migration. Recent studies suggest in fact that changes in biophysical and biomechanical properties of tumor cells can reversibly control their transition from one type of migration to the other. These changes may be caused by internal cell biomechanical mechanisms as well as mechanical and topological properties of the extracellular matrix. In order to understand the complex transition between the two modes and the role played by internal cellular mechanics during migration, we have developed a novel axisymmetric hyperviscoelastic cell model to simulate the dynamical behavior of a migrating cell. Numerical results from our study quantitatively demonstrate that the biomechanical properties of the cell may play an important role in the amoeboid-mesenchymal transition during migration. Our study will therefore not only help in creating a new platform for simulating cellular processes but will also provide insights into the role of sub-cellular mechanics in regulating various modes of migration during tumor invasion and metastasis.

Influence of sumatriptan on gastric accommodation and on antral contraction in healthy subjects assessed by ultrasonography

BACKGROUND

Oral sumatriptan administration has been reported to delay gastric emptying after liquid meals. The aim of this study was to determine whether delayed gastric emptying is caused by enhanced gastric accommodation, impaired antral contractions, or both using ultrasonography.

METHODS

Ten healthy volunteers were enrolled in this randomized two-way crossover study. After overnight fasting, the subjects received the liquid meal 60 min after ingesting a 50 mg sumatriptan tablet with 50 mL of water or 50 mL of water alone (control). The cross-sectional area of the proximal stomach was measured in a supine position after every 100 mL. The frequency and amplitude of the antral contractions were measured in a slightly backward sitting position. The intragastric distribution of the liquid meal was assessed by calculating the proximal stomach/distal stomach ratio (prox/distal ratio).

KEY RESULTS

The cross-sectional area after drinking 100, 200, and 300 mL of the liquid meal (oral sumatriptan vs control) was 34.49 vs 15.11 cm(2) (P = 0.0051), 48.00 vs 30.61 cm(2) (P = 0.0166), and 58.67 vs 47.19 cm(2) (P = 0.0125), respectively. There was no significant difference in the amplitude of contractions, contraction cycle, motility index, and prox/distal ratio (97.15 vs 97.93%, P = 0.0745; 19.42 vs 19.5 s, P= 0.8590; and 887.58 vs 889.22, P = 0.5751; 9.75 vs 8.41, P = 0.8785; respectively).

CONCLUSIONS & INFERENCES

Oral sumatriptan administration enhanced gastric accommodation after the ingestion of liquid nutrients, but had no significant effect on antral contractions or intragastric distribution in healthy subjects.

Upregulation of ERCC1 and DPD expressions after oxaliplatin-based first-line chemotherapy for metastatic colorectal cancer

BACKGROUND

The updated randomised phase 2/3 FIRIS study demonstrated the noninferiority of IRIS (irinotecan and S-1) to FOLFIRI (irinotecan, folinic acid, and 5-FU) for metastatic colorectal cancer. Meanwhile, in the subset analysis including patients who previously have undergone oxaliplatin-containing chemotherapy, the IRIS group showed longer survival than the FOLFIRI group. However, the molecular mechanism underlying this result is still unknown.

METHODS

The National Cancer Institute 60 (NCI60) cell line panel data were utilised to build the hypothesis. A total of 45 irinotecan-naive metastatic colorectal cancer patients who had undergone hepatic resection were included for the validation study. The mRNA expressions of excision repair cross-complementing group 1 (ERCC1), dihydropyrimidine dehydrogenase (DPD), and topoisomerase-1 (TOP1) were evaluated by quantitative RT-PCR. The expressions of ERCC1 and DPD were also evaluated by immunohistochemistry.

RESULTS

Sensitivity to oxaliplatin in 60 cell lines was significantly correlated with that of 5-FU. Resistant cells to oxaliplatin showed significantly higher ERCC1 and DPD expression than sensitive cells. In validation study, ERCC1 and DPD but not TOP1 expressions in cancer cells were significantly higher in FOLFOX (oxaliplatin, folinic acid, and 5-FU)-treated patients (N=24) than nontreated patients (N=21). The ERCC1 and DPD protein expressions were also significantly higher in FOLFOX-treated patients.

CONCLUSION

The ERCC1 and DPD expression levels at both mRNA and protein levels were significantly higher in patients with oxaliplatin as a first-line chemotherapy than those without oxaliplatin. The IRIS regimens with the DPD inhibitory fluoropyrimidine may show superior activity against DPD-high tumours (e.g., tumours treated with oxaliplatin) compared with FOLFIRI.