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.

Deiodinase 2 upregulation demonstrated in osteoarthritis patients cartilage causes cartilage destruction in tissue-specific transgenic rats

OBJECTIVE

Chondrocyte hypertrophy followed by cartilage destruction is a crucial step for osteoarthritis (OA) development, however, the underlying mechanism remains largely unknown. The objectives of this study are to identify the gene that may cause cartilage hypertrophy and to elucidate its role on OA pathogenesis.

DESIGN

Gene expression profiles of cartilages from OA patients and normal subjects were examined by microarray analysis. Expression of deiodinases, enzymes for regulation of triiodothyronine (T3) biosynthesis, in human and rat articular cartilage (AC) were examined by real-time quantitative reverse transcriptase-polymerase chain reaction (qRT-PCR). Rat ACs and chondrocytes were treated with T3 to investigate its role on chondrocyte hypertrophy and inflammatory reaction. Cartilage-specific Type II deiodinase (DIO2) transgenic rats were generated using bacterial artificial chromosome harboring the entire rat Col2a1 and human DIO2 gene. An experimental OA model was created in the animal to examine the role of DIO2 on cartilage degeneration.

RESULTS

DIO2 is highly expressed in OA patient AC compared to normal control. In rat AC, DIO2 is specifically expressed among deiodinases and dominantly expressed the same as in brown adipose tissue. T3 induces hypertrophic markers in articular chondrocyte and cartilage explant culture, and enhances the effect of IL-1α on induction of cartilage degrading enzymes. Importantly, cartilage-specific DIO2 transgenic rats are more susceptible to knee joint destabilization and develop severe AC destruction.

CONCLUSION

Our findings demonstrate that upregulated expression of DIO2 in OA patient cartilage might be responsible for OA pathogenesis by enhancing the chondrocyte hypertrophy and inflammatory response.

Immune cell infiltration as an indicator of the immune microenvironment of pancreatic cancer

Background:

The host immune reaction is represented by immune/inflammatory cell infiltrates. Here we systematically analysed tumour-infiltrating immune/inflammatory cells in pancreatic ductal carcinoma (PDC) and evaluated their clinicopathological impact.

Methods:

Using immunohistochemistry, we examined tumour-infiltrating CD68⁺ pan-macrophages, HLA-DR⁺CD68⁺ M1 macrophages (M1), CD163⁺ or CD204⁺ M2 macrophages (M2), CD66b⁺ neutrophils (Neu), CD4⁺ T cells (CD4⁺T), CD8⁺ T cells (CD8⁺T), and FOXP3⁺CD4⁺ regulatory T cells (Treg) in 212 cases of PDC, and conducted correlation and survival analyses using the Kaplan–Meier method and Cox proportional hazards model.

Results:

Higher levels of tumour-infiltrating pan-macrophages, M2, Neu, or the ratio of Tregs to CD4⁺T (%Treg) were significantly associated with shorter survival, whereas higher levels of tumour-infiltrating CD4⁺T, CD8⁺T, or the ratio of M1 to pan-macrophages (%M1) were significantly associated with longer survival. Survival analysis of pairs of these variables revealed that some of the resulting patient groups had exclusively longer survival. We then connected the apparently related factors, and two significant variables emerged: tumour-infiltrating CD4⁺T^high/CD8⁺T^high/%Treg^low and tumour-infiltrating %M1^high/M2^low. Multivariate survival analysis revealed that these variables were significantly correlated with longer survival and had a higher hazard ratio.

Conclusion:

Tumour-infiltrating CD4⁺T^high/CD8⁺T^high/%Treg^low and %M1^high/M2^low are independent prognosticators useful for evaluating the immune microenvironment of PDC.

Longitudinal distortions and transversal fluctuations of an actin filament sliding on Myosin molecules

An actin filament sliding on myosin moleculesdemonstrates both longitudinal distortions and transversal fluctuationswith the linear dimension far exceeding the diameter of an actinmonomer. Local swaying of a single actin filament was identified byreading speckled fluorescent markers attached on the filament. Theaccuracy of reading each speckled marker was about 10.4 nm (r.m.s.).Longitudinal distortions of an actin filament at a low ATP concentrationof 20 μM were as much as 0.5 μm for the average filament lengthof 5.4 μm. The magnitude of transversal fluctuations was as much as60 nm, that was independent of the filament length. Both longitudinaldistortions and transversal fluctuations are suggested to play a pivotalrole for facilitating a smooth sliding movement of an actin filament.

Regulation of the brain dopaminergic system by juvenile hormone in honey bee males (Apis mellifera L.)

Dopamine (DA) and juvenile hormone (JH) are multifunctional regulators of behaviour in social insects, with distinct effects across species and even between different dominance positions within the same species. We examined the effects of JH on the brain dopaminergic system in honey bee males to investigate the potential relationship between JH and DA within Apis mellifera. Both DA content and the expression of three DA receptor genes (Amdop1, Amdop2 and Amdop3) increased in the male honey bee brain from day 4 to day 8 after emergence. Treatment of 4-day-old males with a JH analogue (methoprene, JHA) enhanced brain DA levels. Brain expression of Amdop1 was also enhanced by JHA but not by a DA receptor agonist 2-amino 6,7-dihydroxy-1,2,3,4-tetrahydronaphthalene (6,7-ADTN), indicating that Amdop1 up-regulation was not mediated by increased DA receptor stimulation. Furthermore, Amdop1 expression was still enhanced when JHA was co-applied with the DA receptor antagonist cis-(Z)-flupenthixol. Expression levels of Amdop2 and Amdop3 were not altered by JHA, 6,7-ADTN or by JHA plus the DA receptor antagonist. Regulation of the brain dopaminergic system by JH, as observed in solitary species, is conserved in male honey bees but not in female honey bees and other advanced eusocial insects.

High-energy anomaly in the band dispersion of the ruthenate superconductor

We reveal a "high-energy anomaly" (HEA) in the band dispersion of the unconventional ruthenate superconductor Sr2RuO4, by means of high-resolution angle-resolved photoemission spectroscopy (ARPES) with tunable energy and polarization of incident photons. This observation provides another class of correlated materials exhibiting this anomaly beyond high-T(c) cuprates. We demonstrate that two distinct types of band renormalization associated with and without the HEA occur as a natural consequence of the energetics in the bandwidth and the energy scale of the HEA. Our results are well reproduced by a simple analytical form of the self-energy based on the Fermi-liquid theory, indicating that the HEA exists at a characteristic energy scale of the multielectron excitations. We propose that the HEA universally emerges if the systems have such a characteristic energy scale inside of the bandwidth.

Experimental verification of PbBi2Te4 as a 3D topological insulator

The experimental evidence is presented of the topological insulator state in PbBi2Te4. A single surface Dirac cone is observed by angle-resolved photoemission spectroscopy with synchrotron radiation. Topological invariants Z2 are calculated from the ab initio band structure to be 1;(111). The observed two-dimensional isoenergy contours in the bulk energy gap are found to be the largest among the known three-dimensional topological insulators. This opens a pathway to achieving a sufficiently large spin current density in future spintronic devices.

Spin-polarized Dirac-cone-like surface state with d character at W(110)

The surface of W(110) exhibits a Dirac-cone-like state with d character within a spin-orbit-induced symmetry gap. As a function of the wave vector parallel to the surface, it shows a nearly massless energy dispersion and a pronounced spin polarization, which is antisymmetric with respect to the Brillouin zone center. In addition, the observed constant energy contours are strongly anisotropic for all energies. This discovery opens new pathways to the study of surface spin-density waves arising from a strong Fermi surface nesting as well as d-electron-based topological properties.

P3-15-02: The Change of Bone Turnover Markers during Neoadjuvant Anastrozole Versus Exemestane: A Randomized Single-Center Study

Background: Non-steroidal aromatase inhibitors including anastrozole and letrozole have been reported to increase the rate of bone turnover, accelerate loss of bone, and increase the incidence of fractures. Although steroidal inactivator exemestane has similar inhibitory effect on the aromatization, animal studies have shown a weak but potentially important anabolic effect of exemestane metabolites, which might lead to decreased bone resorption. This randomized trial was conducted to compare the effect of exemestane and anastorozole on bone turnover markers.

Patients and Methods: Fifty-two postmenopausal women with ER-positive, HER2−negative, invasive, nonmetastatic, and operable breast cancer were randomly assigned to neoadjuvant exemestane (25 mg daily) or anastrozole (1 mg daily) for 4 months. The primary endpoint was change in bone turnover markers including resorption markers urinary and serum N-telopeptide (NTX) and the formation markers serum bone alkaline phosphatase (BAP). The secondary endpoint was tumor objective response (OR) assessed by both caliper and ultrasound. Comparisons were also made of breast conservation rate and adverse events.

Results: The changes in serum NTX from baseline to week 16 were not statistically different between anastrozole and exemestane. The changes in urinary NTX from baseline to week 16 were also not statistically different between both groups .BAP did not show any significant increase in the exemestane group (10.8%; p=0.21), whereas the increase in BAP from baseline to week 16 in the anastrozole group was 15.0% and marginally significant (p=0.05). There were no significant differences in OR in the intent-to-treat population between patients receiving anastrozole or exemestane (45.8% vs. 39.2%; p=0.63). The OR was similar between the patients with a baseline Ki67 index of ≥15% and &lt;15% in exemestane group (37.5% vs. 41.2%; p=0.86). In anastrozole group the OR in patients with a baseline Ki67 index of ≥15% and &lt;15% was 44.4% and 53.8%, respectively(p=0.66). Breast conservation rate was similar between anastrozole and exemestane (62.5% vs. 67.9%; p=0.68). Treatment was well tolerated and much the same for both groups.

Conclusions: There is no significant differences of the change in bone turnover markers between anastrozole and exemestane. These results indicate exemestane had no anabolic effects which would lead to fewer adverse effects on bone.

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P3-15-02.