Abstract
Background
The procedure for mediastinal lymph node dissection using a laparoscopic transhiatal approach (LTHA) had not been established for esophageal and esophagogastric junction (EGJ) ...cancers because of the difficulties associated with surgery. We developed a novel and simple technique for their en-bloc dissection using LTHA. To date, 296 patients had undergone our method during various esophageal surgical procedures, including 39 cases with EGJ cancer. We describe our technique and evaluate the optimal range of mediastinal lymph node dissection for EGJ cancer.
Methods
The esophageal hiatus was opened and CO2 was introduced into the mediastinum. The posterior plane of the pericardium was extended, and the anterior side of the subcarinal, main bronchial, thoracic paraaortic and pulmonary ligament lymph nodes were separated. The posterior side of these lymph nodes was then separated. Finally, while lifting lymph nodes like a membrane, they were resected from bilateral mediastinal pleura, main bronchi and tracheal bifurcation.
Results
1) Patients with EGJ cancers performed middle and lower mediastinal lymph node dissection by LTHA (n = 39) were compared with those performed by the right thoracotomy (n = 41). The total operative time and bleeding were significantly decreased by LTHA. The number of resected middle and lower mediastinal lymph nodes, pR0 rate, and mediastinal recurrence in the two groups were not different. In 87.2% of patients treated by LTHA, extubation was performed at 0 POD. Postoperative respiratory complications was decreased by LTHA (LTHA: 7.7%, thoracotomy: 17.0%). 2) Patients with EGJ cancers performed total mediastinal lymph node dissection by thoracotomy for the time before introducing LTHA were analyzed (n = 37). Upper and/or middle mediastinal lymph nodes metastasis was observed in 10 cases, and all of them had advanced tumors. All of 6 cases with upper mediastinal lymph nodes metastasis were squamous cell carcinoma. Even in adenocarcinoma, middle mediastinal lymph node metastasis was observed in 2 cases, suggesting the importance of mediastinal lymph node dissection for advanced EGJ cancers.
Conclusion
Our surgical procedure resulted in a good surgical view, safe en-bloc mediastinal lymph node dissection, and the decrease of postoperative respiratory complications.
Disclosure
All authors have declared no conflicts of interest.
Abstract
Background
Recent studies revealed that membrane proteins, such as ion transporters, are specifically activated in cancer stem cells (CSCs). Therefore, these molecules are receiving a great ...attention as new chemotherapeutic targets of malignant tumor. This study aimed to investigate the expression and activity of ion transport-related molecules in CSCs of esophageal squamous cell carcinoma (ESCC).
Methods
We sorted cells with high expression of ALDH1A1 via FACS, and then, CSCs were generated using the sphere formation assay. The gene expression profiles of CSCs were examined using a microarray analysis. Candidate genes of membrane proteins activated in CSCs were selected based on that microarray data. Anticancer effects induced by inhibition of the selected proteins were examined.
Results
ALDH1A1 mRNA and protein levels were certainly upregulated in CSCs compared with non-CSCs. Obtained CSCs were resistant to Cisplatin and had the ability of re-differentiation. The results of the microarray analysis revealed that expressions of 50 genes of plasma membrane proteins were changed in CSCs, and that several genes related to ion channels, including transient receptor potential cation channel subfamily V member 2 (TRPV2), were upregulated. The upregulation of TRPV2 mRNA were also validated in CSCs derived from two types of esophageal cancer cell lines using RT-PCR method. Tranilast, which is specific TRPV2 inhibitor, was more cytotoxic at lower concentration in CSCs than in non-CSCs, and effectively decreased the number of tumorspheres. Further, Tranilast significantly decreased the cell population with high ALDH1A1 expression in esophageal cancer cells.
Conclusion
The results of the present study suggest that TRPV2 is involved in the maintenance of CSCs, and Tranilast, which is specific inhibitor of TRPV2, becomes a promising targeted therapeutic agent against ESCC.
Disclosure
All authors have declared no conflicts of interest.
We report here a case of a 78-year-old woman, who underwent mastectomy for breast cancer. Mammography showed a mass in the right MO area with an unclear boundary. Ultrasound examination revealed an ...irregular mass of 40×29×19mm in the right C region. Dynamic contrast-enhanced MRI showed a 34mm tumor with contrast effect in the C area of the right breast. We performed a core needle biopsy on the mass, and the histopathological diagnosis was apocrine carcinoma(ER-, PgR-, HER2 3+, and Ki-67 30%)of clinical T2N0M0, stageⅡA. Right mastectomy and sentinel lymph node biopsy were performed. In the postoperative pathological examination, the main lesion was apocrine carcinoma(ER-, PgR-, HER2 3+, Ki-67 20%)and Paget's disease(ER-, PgR-, HER2 3+, Ki-67 30%). After surgery, the patient was given trastuzumab therapy.
Since breast reconstruction has been covered by health insurance, we can choose a procedure that combines the cosmetic satisfaction of patients with curability. We report about a patient with breast ...cancer that who underwent nipple-sparing mastectomy after evaluating the intraductal spread by automated breast ultrasound system(ABUS), while hand held ultrasound( HHUS)showed only limited information on the intraductal spread of the lesion. A 52-year old woman with an abnormal screening finding was referred to our hospital. HHUS showed an irregular and poorly defined hypoechoic mass lesion with a lactiferous duct extending to directly under the nipple. A core needle biopsy revealed invasive ductal carcinoma. We performed ABUS to assess the intraductal spread in the lesion because the patient requested breast reconstruction. The coronal section of the breast in the ABUS did not showintraductal spread. We, therefore, decided to perform a nipple-sparing mastectomy and sentinel lymph node biopsy. Intraoperative evaluation by frozen and permanent sections showed negative margins. The ABUS findings helped in the evaluation of the intraductal spread of the lesion and in the choice of the optimal procedure for the patient.
Mammography is the standard screening toolfor post-operative breast cancer, with annualcheck -ups recommended; however, it misses some cancers. We report a case a metachronous contralateral breast ...cancer detected by breast ultrasound 8 years and 6 months after operation. A 72-year-old women visited our hospital for follow-up 8 years and 6 months after the operation. She was diagnosed with right breast cancer at 63 years of age and underwent partial mastectomy with axially lymph node dissection. The pathological diagnose was scirrhous carcinoma. After chemotherapy and radiation therapy, she underwent screening with annual examinations. The mammography finding was normal, but an ultrasound showed a mass lesion in the contralateral breast. The pathological diagnosis of the biopsy specimen was mucinous carcinoma. A history of breast cancer is known to suggest an increased risk of metachronous contralateral breast cancer. Therefore, regular follow-up with breast ultrasound, not only mammography, is recommended.
Cultured cells of Phytolacca americana, which had been cultivated in the dark, biotransformed resveratrol to pinostilbene and pterostilbene 4′-O-β-d-glucoside, together with the 3- and ...4′-O-β-D-glucosides of resveratrol. Pinostilbene was converted into its 3-O-β-d-glucoside and pterostilbene. In addition, the cells transformed piceatannol to its 4′-O-β-d-glucoside, isorhapontigenin, and isorhapontigenin 3-O-β-D-glucoside.
PPAR gamma is a ligand-activated transcription factor and functions as a heterodimer with a retinoid X receptor (RXR). Supraphysiological activation of PPAR gamma by thiazolidinediones can reduce ...insulin resistance and hyperglycemia in type 2 diabetes, but these drugs can also cause weight gain. Quite unexpectedly, a moderate reduction of PPAR gamma activity observed in heterozygous PPAR gamma -deficient mice or the Pro12Ala polymorphism in human PPAR gamma , has been shown to prevent insulin resistance and obesity induced by a high-fat diet. In this study, we investigated whether functional antagonism toward PPAR gamma /RXR could be used to treat obesity and type 2 diabetes. We show herein that an RXR antagonist and a PPAR gamma antagonist decrease triglyceride (TG) content in white adipose tissue, skeletal muscle, and liver. These inhibitors potentiated leptin's effects and increased fatty acid combustion and energy dissipation, thereby ameliorating HF diet-induced obesity and insulin resistance. Paradoxically, treatment of heterozygous PPAR gamma -deficient mice with an RXR antagonist or a PPAR gamma antagonist depletes white adipose tissue and markedly decreases leptin levels and energy dissipation, which increases TG content in skeletal muscle and the liver, thereby leading to the re-emergence of insulin resistance. Our data suggested that appropriate functional antagonism of PPAR gamma /RXR may be logical.
Abstract
The dependence of the single-particle strength on the difference between proton and neutron separation energies is studied for oxygen isotopes in a wide range of isospins. The cross sections ...of the quasi-free ($p,2p$) reaction on $^{14,16,18,22,24}$O were measured at intermediate energies. The measured cross sections are compared to predictions based on the distorted wave impulse approximation and shell-model $psd$ valence-space spectroscopic factors. The reduction factors, which are the ratio of the experimental cross sections to the theoretical predictions, show no apparent dependence on the proton–neutron separation energy difference. The result is compatible with the result of the ($e,e^{\prime}p$) reaction on stable targets and with the predictions of recent ab initio calculations.
Silver Degenerate States
In article number 2204672, using high‐resolution transmission electron microscopy (HRTEM), Titus Masese, Godwill Mbiti Kanyolo, and co‐workers report novel honeycomb layered ...oxides exhibiting silveratom bilayers. The bilayers are theoretically understood via emergent SU(2) interactions with three distinct states of silver associated with fractional valency (sub‐valent) states, alongside conventional U(1) (electromagnetic) interaction. Breaking the SU(2)×U(1) symmetry, analogous to electroweak theory, generates silver mass terms manifesting as the bilayered structure.
The aim of this study was to investigate factors associated with the development of parenteral nutrition-associated liver disease (PNALD) and to examine the clinicopathological relationship of PNALD ...in extremely low-birthweight infants (ELBWI).
The subjects were 13 ELBWI who had received PN because of intestinal perforation or functional ileus between 2000 and 2013. We measured the serum levels of biochemical parameters, including aspartate aminotransferase, alanine aminotransferase, and direct bilirubin. Liver histopathology was examined in relation to outcome. The subjects were categorized into two groups on liver histopathology: F(+), development of hepatic fibrosis and necrosis with/without cholestasis; and F(-), no hepatic fibrosis.
Of 13 ELBWI, five died of hepatic failure, five died of sepsis, and the other three were alive at the time of the study. Of the five infants who died of hepatic failure, two developed fulminant hepatitis without cholestasis, and the other three developed chronic cholestasis and finally hepatic failure. Postmortem histopathology in F(+) indicated not only massive hepatic necrosis, but also massive hepatic fibrosis. These histopathological findings explained the clinical presentation of portal hypertension. There were significant differences in the fasting period after intestinal disease onset between the two groups.
The prolonged fasting with PN is responsible for severe hepatocellular necrosis with fibrosis and consequent lethal portal hypertension.
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