Hepatic Stellate Cells May Relate to Progression of Intrahepatic Cholangiocarcinoma

Background  Although cumulative evidence supports the fact that stromal myofibroblasts promote tumor progression, the influence of myofibroblasts on intrahepatic cholangiocarcinoma (ICC) is unclear. We hypothesized that hepatic stellate (HS) cells can differentiate into myofibroblasts in ICC stroma and that they promote cancer progression. This study aims to: (1) assess the influence of myofibroblasts on the prognosis of ICC, (2) identify HS cells in ICC stroma, and (3) investigate the interaction between HS cells (LI90 and LX-2) and ICC cells (HuCCT-1 and MEC) in vitro. Methods  The association between α-smooth muscle actin (α-SMA) expression and the prognoses of 46 ICC patients after hepatic resection was evaluated by immunohistochemical analysis. The HS cells in myofibroblasts of ICC were identified (double immunostaining) using antibodies for α-SMA, glial fibrillary acidic protein (GFAP), and desmin. The influence of HS cells on the invasion and growth of ICC cells was examined in vitro using a coculture system. Results  Patients with high α-SMA expression exhibited the worse outcomes. Multivariate analyses revealed that high α-SMA expression (P = 0.0045) and positivity for lymph-node metastasis were independent prognostic factors. Because desmin- or GFAP-positive cells coexpressing α-SMA were observed in the ICC samples, they were considered to be derived from the HS cells. On coculturing with HS cells, a remarkable increase was observed in the invasion and growth of the two ICC cell lines. Conclusions  Stromal myofibroblasts may relate to the poor prognoses in ICC patients. HS cells appear to be involved in the progression of ICC.     

Clinicopathological outcomes of preoperative chemoradiotherapy using S-1 plus Irinotecan for T4 lower rectal cancer

Purpose

To investigate the clinicopathological outcomes of patients with T4 lower rectal cancer treated using preoperative chemoradiotherapy with S-1 plus Irinotecan.

Methods

Between 2005 and 2011, 35 patients with T4M0 lower rectal cancer, diagnosed initially as T4a in 12 and as T4b in 23, were treated with 45 Gy of radiotherapy concomitantly with S-1 plus Irinotecan. The median follow-up period was 50.6 months (range 2–123 months).

Results

A total of 32 patients (91.4 %) completed the radiotherapy and 26 (74.3 %) completed the full chemotherapy regimen. Radical surgery was then performed in 33 (94.3 %) of the 35 patients after the exclusion of two patients, who had macroscopic residual disease. The pathological diagnosis was downstaged from T4a to ypT0-3 in all 12 of those patients (100 %) and from T4b to ypT0-4a in 20 of those 23 patients (87.0 %). The tumor regression grade of 1a/1b/2/3 (complete response) was 10/8/15/2, respectively. In terms of long-term survival, the 5-year local relapse-free survival rate was 74.8 % and the recurrence-free survival rate was 52.0 %.

Conclusions

This regimen may result in favorable downstaging. Moreover, in this series, pathological evidence of involvement of adjacent organs was rare following preoperative chemoradiotherapy, in the patients with disease diagnosed as T4b at the initial staging.

     

Obstructing small bowel bezoars due to an agar diet: diagnosis using double balloon enteroscopy

Primary small bowel bezoars are rare and may cause acute abdomen due to small bowel obstruction (SBO). A 70-year-old Japanese woman presented to the emergency room with abdominal pain, nausea and vomiting. The patient reported that she had eaten a large amount of highly-concentrated, agar dissolved in boiling water two days prior to presentation. Double balloon enteroscopy (DBE) revealed that white-colored, hard bezoars were clogged in the jejunum. At surgery, many bezoars were found impacted in the distal jejunum, and enterotomy was performed. The bezoars were elastic hard, crystallized objects. These bezoars were considered to have formed from highly-concentrated, dissolvable agar.     

Relationship between cytokine concentration and activities of daily living in rehabilitation patients with stroke

Stroke rehabilitation is effective in some patients, however not so effective in others. Our ultimate aim is to use the clinical laboratory assessment as a tool for effectiveness discrimination in rehabilitation. Subjects were 15 stroke patients (68.1 +/- 12.7 years old) who were admitted to our convalescent rehabilitation wards. Fasting blood samples were analyzed for serum concentrations of hepatocyte growth factor (HGF), vascular endothelial growth factor (VEGF) and insulin-like growth factor-I (IGF-I) which are considered to be involved in hypermyotrophy using ELISA methods on admission and at discharge. Sixteen healthy control subjects (63.0 +/- 7.6 years old) were also employed. As accuracy control of these analyses, decrease of serum HGF after keeping at -20 degrees C for 499 days were measured. The concentration was 0.66ng/mL from 0.71 ng/mL and residual ratio was 94.0%. Reaction specificity to MW 60 kDa HGF antibody using the Western blot method was confirmed. Average HGF and VEGF were higher in stroke patients than those in control subjects. Average IGF-I was lower in stroke patients. The correlations between HGF, VEGF, and IGF-I and the score of activities of daily living expressed by the Functional Independence Measure (FIM) were calculated. Highest correlation coefficient of 0.67 (p < 0.01) was obtained between HGF at discharge and the FIM efficiency (the gain of the FIM during hospitalization divided by length of stay). The correlation coefficients related to VEGF or IGF showed lower value. High FIM efficiency denotes rapid recovery with vigorous exercise. HGF at discharge would reflect the result of high activity.