Robotic-assisted lateral lymph node dissection for lower rectal cancer: short-term outcomes in 50 consecutive patients

Background

The goal of this study was to evaluate the short-term outcomes of robotic-assisted lateral lymph node dissection for patients with advanced lower rectal cancer.

Methods

Between 2012 and 2013, 50 consecutive patients underwent robotic-assisted lateral lymph node dissection for rectal cancer in Shizuoka Cancer Center Hospital. Perioperative outcomes including operative time, operative blood loss, length of stay, postoperative complications, and histopathological data were collected prospectively.

Results

Median patient age was 62 years (range 36–74 years). Operative procedures included low anterior resections (n = 27), intersphincteric resections (n = 16), and abdominoperineal resections (n = 7). Bilateral lymph node dissection was performed in 44 patients. The median operative time was 476 min (range 320–683 min), and the median time required for lateral lymph node dissection was 165 min (range 85–257 min). The median blood loss was 27 mL (range 5–690 mL). There were no cases of open surgery or laparoscopic conversion. The median duration of postoperative hospital stay was 8 days (range 6–13 days). Clavien–Dindo classification Grade III–IV complications occurred in only one patient (2.0 %). There were no cases of anastomotic leak. There was no perioperative mortality. The median number of harvested lateral lymph nodes was 19 (range 5–47).

Conclusions

Robotic-assisted lateral lymph node dissection is a safe, feasible, and useful approach for patients with advanced lower rectal cancer.

     

Alteration of the Intestinal Environment by Lubiprostone Is Associated with Amelioration of Adenine-Induced CKD

The accumulation of uremic toxins is involved in the progression of CKD. Various uremic toxins are derived from gut microbiota, and an imbalance of gut microbiota or dysbiosis is related to renal failure. However, the pathophysiologic mechanisms underlying the relationship between the gut microbiota and renal failure are still obscure. Using an adenine-induced renal failure mouse model, we evaluated the effects of the ClC-2 chloride channel activator lubiprostone (commonly used for the treatment of constipation) on CKD. Oral administration of lubiprostone (500 µg/kg per day) changed the fecal and intestinal properties in mice with renal failure. Additionally, lubiprostone treatment reduced the elevated BUN and protected against tubulointerstitial damage, renal fibrosis, and inflammation. Gut microbiome analysis of 16S rRNA genes in the renal failure mice showed that lubiprostone treatment altered their microbial composition, especially the recovery of the levels of the Lactobacillaceae family and Prevotella genus, which were significantly reduced in the renal failure mice. Furthermore, capillary electrophoresis–mass spectrometry-based metabolome analysis showed that lubiprostone treatment decreased the plasma level of uremic toxins, such as indoxyl sulfate and hippurate, which are derived from gut microbiota, and a more recently discovered uremic toxin, trans-aconitate. These results suggest that lubiprostone ameliorates the progression of CKD and the accumulation of uremic toxins by improving the gut microbiota and intestinal environment.     

Clinical assessment of chewing function of obturator prosthesis wearers by objective measurement of masticatory performance and maximum occlusal force

PURPOSE: Eating, which includes chewing and swallowing, is an oral function that influences quality of life. Though the swallowing ability of maxillectomy patients was reported in our previous study, the chewing function has not been fully reported to date. Thus, the purpose of this study was to evaluate the chewing function of obturator prosthesis wearers by measurement of masticatory performance and occlusal force. The relationship of these 2 measurements was also investigated. MATERIALS AND METHODS: Twenty maxillofacial obturator prosthesis wearers undergoing periodic checkup at the maxillofacial rehabilitation clinic in Kyushu University Hospital were recruited for this study. Additionally, 20 young, healthy individuals were recruited as controls. Data on masticatory performance, which was measured by a sieve method using hydrocolloid material, and maximum occlusal force, which was measured by the Dental Prescale System (Fuji Film), were obtained for each participant. RESULTS: The mean of masticatory performance was 2.6 (SD 1.2) on a 1.40-mm mesh. There was no significant difference in masticatory performance between the patient group and the controls. The mean maximum occlusal force of the patient group was 625.9 N (SD 299.1 N), which was significantly lower than that of the control group. There was no significant correlation between masticatory performance and maximum occlusal force for the patient group in this study (P = .3726). CONCLUSION: Masticatory performance of obturator prosthesis wearers with dentate or partially edentulous maxillae was not different from that of young, healthy individuals, though maximum occlusal force of these patients was lower than that of controls.     

Cytological findings of ROS1‐rearranged lung adenocarcinoma

ROS1‐rearranged lung adenocarcinoma has been recently identified. We report a case of ROS1‐rearranged lung adenocarcinoma with special emphasis on cytological findings. Here, we report a case of young woman with ROS1‐rearranged lung adenocarcinoma diagnosed by cytology and discuss the clinical, cytological, and molecular findings. Cytologically, the tumor consisted of small tight clusters of cells with high nuclear/cytoplasmic ratio. Nuclei were enlarged and small nucleoli were occasionally observed. Signet‐ring cells were focally identified. Neoplastic cells were positive for ROS1 immunocytochemistry. Subsequently, the translocation of ROS1 gene was confirmed in a histological specimen. In conclusion, the specific histology of adenocarcinoma on cytological materials should promote testing for ROS1 immunohistochemistry. Immunocytochemical detection of ROS1 protein helps identify patients suitable for molecular targeted therapy.     

Incidence of penicillin-resistantstreptococcus pneumoniae in Japan, 1993–1995

The Working Group for PRSP was organized through the participation of 40 institutions to investigate the incidence of penicillin (Pc)-resistantStreptococcus pneumoniae (PRSP) in Japan. We collected 2410S. pneumoniae clinical isolates between October 1994 and March 1995. The susceptibility to Pc, erythromycin, and minocycline was determined by an agar dilution method using Mueller-Hinton agar supplemented with 5% sheep blood. Pc-susceptibleS. pneumoniae (PSSP) were defined as bacteria for which the minimum inhibitory concentration (MIC) was ≤0.06 μg/mL; Pc-intermediateS. pneumoniae (PISP) as those for which the MIC ranged from 0.125 to 0.25 μg/mL; PRSP, as those with a MIC≥0.5μg/mL. The incidence of resistant strains including PISP and PRSP was 41.8% in 1994 and 40.8% in 1995. Logistic regression analysis showed that PRSP was significantly more frequent in infants aged 0 to 2 years old than in the general population and PSSP was significantly more frequent in elderly patients aged 60 or older. The rate of PRSP was significantly higher in the throat than in the sputum. Among 10 regions studied nationwide, PRSP was detected less frequently in the areas of Hokkaido and Hokuriku and more frequently in the areas of Chugoku, Shikoku, and Kyushu. Most PRSP were resistant to erythromycin and minocycline. PSSP serotyping using the capsule-quellung reaction indicated a number of types. In contrast, most PISP and PRSP were serotyped to types 19, 23, and 6.     

Sensitization of TRPA1 by PAR2 contributes to the sensation of inflammatory pain

Proinflammatory agents trypsin and mast cell tryptase cleave and activate PAR2, which is expressed on sensory nerves to cause neurogenic inflammation. Transient receptor potential A1 (TRPA1) is an excitatory ion channel on primary sensory nerves of pain pathway. Here, we show that a functional interaction of PAR2 and TRPA1 in dorsal root ganglion (DRG) neurons could contribute to the sensation of inflammatory pain. Frequent colocalization of TRPA1 with PAR2 was found in rat DRG neurons. PAR2 activation increased the TRPA1 currents evoked by its agonists in HEK293 cells transfected with TRPA1, as well as DRG neurons. Application of phospholipase C (PLC) inhibitors or phosphatidylinositol-4,5-bisphosphate (PIP(2)) suppressed this potentiation. Decrease of plasma membrane PIP(2) levels through antibody sequestration or PLC-mediated hydrolysis mimicked the potentiating effects of PAR2 activation at the cellular level. Thus, the increased TRPA1 sensitivity may have been due to activation of PLC, which releases the inhibition of TRPA1 from plasma membrane PIP(2). These results identify for the first time to our knowledge a sensitization mechanism of TRPA1 and a novel mechanism through which trypsin or tryptase released in response to tissue inflammation might trigger the sensation of pain by TRPA1 activation.