IHPBA concordant classification of primary liver cancer: working group report

The working group of the International Scientific Committee of the International Hepato-Pancreato-Biliary Association(IHPBA) examined conventional staging systems and decided to establish a new staging system that depended on macroscopic findings after liver resection. The TNM/International Union Against Cancer (UICC) classification has been widely used but is too complicated. Vauthey and colleagues, and the Liver Cancer Study Group of Japan (LCSGJ) have proposed new simplified classifications. These are compared and discussed. The IHPBA working group proposed a new classification, as follows. T factor. 1. Solitary 2. No more than 2 cm 3. No vascular invasion to portal vein, hepatic vein, and bile duct T1 meets all of the above three requirements.T2 meets two of the three requirements.T3 meets one of the three requirements.T4 does not meet any requirements. Stage: I T1N0M0 II T2N0M0 III T3N0M0IV A T4N0M0 Any TN1M0 IV B Any T/N, M1 The survival curves of each stage were separated clearly (P < 0.0001). The staging system is easy to remember and easy to use. We hope this staging system will be generally used in future.     

Xanthogranulomatous pancreatitis mimicking a malignant cystic tumor of the pancreas: report of a case

Xanthogranulomatous pancreatitis (XGP) is a rare inflammatory disease of the pancreas. A correct diagnosis is usually made only after pathological examination. A 76-year-old man was referred to our hospital for investigation of erythroderma, muscle weakness, and weight loss. We suspected dermatomyositis as a paraneoplastic phenomenon and investigated accordingly. Computed tomography showed a cystic lesion encapsulated by a thick wall in the pancreatic body. On magnetic resonance imaging, the lesion had low intensity on the T1-weighted images and heterogeneously high intensity on the T2-weighted images. ¹⁸F-Fluorodeoxyglucose positron emission tomography showed abnormal uptake with a maximum standardized uptake value of 9.1. Based on these findings, we made a preoperative diagnosis of intraductal papillary-mucinous carcinoma and performed a distal pancreatectomy. Macroscopically, the cyst was surrounded by a yellow-tan mass with an unclear border, and was filled with hemorrhagic and necrotic tissue. Microscopically, the mass contained an aggregation of many foamy histiocytes, lymphocytes, and plasma cells. These microscopic findings were consistent with xanthogranulomatous inflammation, and the lesion was diagnosed as XGP. Although it is a rare benign pancreatic lesion, XGP should nevertheless be considered in the differential diagnosis of cystic lesions of the pancreas.     

Genetic variations in the CYP17A1 and NT5C2 genes are associated with a reduction in visceral and subcutaneous fat areas in Japanese women

Visceral fat accumulation has an important role in increasing the morbidity and mortality rates, by increasing the risk of developing several metabolic disorders, such as type 2 diabetes, dyslipidemia and hypertension. New genetic loci that are associated with increased systolic and diastolic blood pressures have been identified by genome-wide association studies in Caucasian populations. This study investigates whether single nucleotide polymorphisms (SNPs) that confer susceptibility to high blood pressure are also associated with visceral fat obesity. We genotyped 1279 Japanese subjects (556 men and 723 women) who underwent computed tomography for measuring the visceral fat area (VFA) and subcutaneous fat area (SFA) at the following SNPs: FGF5 rs16998073, CACNB2 rs11014166, C10orf107 rs1530440, CYP17A1 rs1004467, NT5C2 rs11191548, PLEKHA7 rs381815, ATP2B1 rs2681472 and rs2681492, ARID3B rs6495112, CSK rs1378942, PLCD3 rs12946454, and ZNF652 rs16948048. In an additive model, risk alleles of the CYP17A1 rs1004467 and NT5C2 rs11191548 were found to be significantly associated with reduced SFA (P=0.00011 and 0.0016, respectively). When the analysis was performed separately in men and women, significant associations of rs1004467 (additive model) and rs11191548 (recessive model) with reduced VFA (P=0.0018 and 0.0022, respectively) and SFA (P=0.00039 and 0.00059, respectively) were observed in women, but not in men. Our results suggest that polymorphisms in the CYP17A1 and NT5C2 genes influence a reduction in both visceral and subcutaneous fat mass in Japanese women.     

Effect of biofield therapy in the human brain

Abstract Objectives: The effects of Okada Purifying Therapy (OPT), a form of subtle energy (biofield) therapy that originated in Japan, were investigated. Electroencephalograms and the Profile of Mood States scores were measured using a crossover design during OPT and placebo sessions. Participants: Nineteen (19) healthy Japanese adults (mean age±standard deviation: 40.8±11.2 years; 10 females) with no previous experience of biofield therapy participated in this study. Methods: Each session lasted 15 minutes. A single-blind, randomized design with a protocol consisting of regular cycles with eyes open followed by eyes closed was used. The power spectral value was calculated in θ (4.0-7.9?Hz), α (8.0-12.9?Hz), and β (13.0-29.9?Hz) frequency ranges. Results: The power spectral value of the α band at F(p1), F(p2), F(7), F(z), F(8), C(3), C(z), C(4), and P(z) increased significantly in the OPT session compared with the placebo session. Mood state was improved after both sessions, and no significant difference was found between the two sessions. Conclusions: OPT was more effective in increasing α waves in the frontal and central cortex than a placebo treatment.     

A novel thermoelectric cooling device using Peltier modules for inducing local hypothermia of the spinal cord: the effect of local electrically controlled cooling for the treatment of spinal cord injuries in conscious rats

We developed a novel thermoelectric cooling device using Peltier modules for the treatment of spinal cord injury in rats. The extracorporeal electrically cooling component was attached to the aluminum arched plate which was placed on the surface of the spinal cord after the contusion injury in the 11th thoracic spinal cord. During the hypothermic treatment, rats were awake and could move in the cage. Hind limb motor function, evaluated using a BBB scale, in the hypothermic animals (33 °C for 48 h) was significantly higher than that in the normothermic animals from 2 weeks to 8 weeks after the injury.     

Association between Helicobacter pylori virulence factors and gastroduodenal diseases in Okinawa, Japan

The incidence of gastric cancer in Okinawa is lowest in Japan. Some previous reports using small number of strains suggested that the high prevalence of Helicobacter pylori with Western-type cagA in Okinawa compared to other areas in Japan might contribute to the low incidence of gastric cancer. It has still not been confirmed why the prevalence of Western-type cagA strains is high in Okinawa. We examined the association between the virulence factors of H. pylori and gastroduodenal diseases in Okinawa. The genotypes of cagA and vacA of 337 H. pylori strains were determined by PCR and gene sequencing. The genealogy of these Western-type cagA strains in Okinawa was analyzed by multilocus sequence typing (MLST). Overall, 86.4% of the strains possessed cagA: 70.3% were East-Asian type and 16.0% were Western type. After adjustment by age and sex, the presence of East-Asian-type cagA/vacA s1m1 genotypes was significantly associated with gastric cancer compared to gastritis (odds ratio = 6.68, 95% confidence interval = 1.73 to 25.8). The structure of Western-type CagA in Okinawa was different from that of typical Western-type CagA found in Western countries. Intriguingly, MLST analysis revealed that the majority of Western-type cagA strains formed individual clusters but not hpEurope. Overall, low prevalence of gastric cancer in Okinawa may result from the high prevalence of non-East-Asian-type cagA strains. The origin of Western-type cagA strains in Okinawa may be different from those of Western countries.     

Anti-rheumatic effect of JAK-inhibitors

Treatment of rheumatoid arthritis (RA) has dramatically developed with the use of biologics targeting inflammatory cytokines. However, expense and parenteral use can cause issues in the initiation and continuation of the treatment. Therefore a new orally available anti-rheumatic drug has been long-awaited. Recently, small-molecule compounds targeting Janus kinase (JAK) has shown clinical efficacy similar to biologics in clinical trials for active RA. Among the JAK-inhibitors, new drug application for tofacitinib is concurrently under review in western and asian countries and is highly expected to become a new anti-rheumatic drug in the near future. In order to evaluate the mode of action, we utilized peripheral blood and synovium from RA patients. Proliferation and cytokine production of CD4+ T cell was prominently reduced and subsequently inhibited cartilage destruction by the synovium. Our result is in line with the inhibitory effect of tofacitinib on joint destruction in RA patients those who were treated with tofacitinib. Therefore, further clinical efficacy is expected in the in the long-term treatment with tofacitinib.     

Effects of NKG2D haplotypes on the cell-surface expression of NKG2D protein on natural killer and CD8 T cells of peripheral blood among atomic-bomb survivors

NKG2D is a primary activating receptor that triggers cell-mediated cytotoxicity in NK cells against tumor and virus-infected cells. We previously identified the NKG2D haplotypes in the natural killer gene complex region on chromosome 12p. Two major haplotype alleles, LNK1 and HNK1, were closely related to low and high natural cytotoxic activity phenotypes, respectively. Furthermore, the haplotype of HNK1/HNK1 has revealed a decreased risk of cancer compared with LNK1/LNK1. In the present study, using flow cytometry, we evaluated the functional effects of NKG2D haplotypes and five htSNPs in terms of the cell-surface expression of NKG2D protein on NK and CD8 T cells of peripheral blood among 732 atomic-bomb survivors. NKG2D expression on NK cells showed significant increases, in the order of LNK1/LNK1, LNK1/HNK1 and HNK1/HNK1 haplotypes (p for trend=0.003), or with major homozygous, heterozygous, and minor homozygous genotypes for individual htSNPs (p for trend=0.02-0.003). The same trend was observed for NKG2D expression on CD8 T cells. Our findings indicate that the NKG2D haplotypes are associated with the expression levels of NKG2D protein on NK and CD8 T cells, resulting in inter-individual variations in human cytotoxic response.