An improvement in the quality of life after performing endoscopic balloon dilation for postoperative anastomotic stricture of the rectum.

A 55-year-old woman underwent a low anterior resection for rectal cancer 7 years earlier at a different hospital. Thereafter, she often had such symptoms as abdominal pain, frequent bowel movements, and constipation. We considered postoperative bowel adhesion to be the cause of these symptoms, and a laparoscopic adhesiotomy was therefore performed twice. However, the symptoms did not substantially improve thereafter. A colonoscope of conventional diameter could barely pass through the anastomotic site of the operation, but we initially judged the anastomotic stricture to not be severe. However, we finally determined the anastomotic stricture to be the cause of these symptoms; X-ray examinations frequently showed the blockage of feces or the collection of gas images in the colon when the symptoms occurred. We therefore performed endoscopic balloon dilation (EBD) after performing electroincision of the scar tissue of the anastomotic ring. We dilated the area of the lesion to a diameter of 20 mm using the EBD technique, and thereafter the patient finally showed an improvement in quality of life. There have been some reports describing the usefulness of EBD for the treatment of colorectal anastomotic stricture. Past studies have reported the indications of EBD to include stricture, which is defined as a narrowed anastomosis through which a 12-mm-diameter colonoscope cannot be passed. Nevertheless, it seemed that when the clinical manifestations of anastomotic stricture are clear, such as those observed in our case, we should not too strictly adhere to this definition.     

Active immunotherapy of tumors with a recombinant xenogeneic endoglin as a model antigen

Angiogenesis play a critical role in tumor growth and metastasis. Increasing evidence suggests that endoglin is a powerful marker of angiogenesis in solid malignancies. Thus, breaking of immune tolerance of self-endoglin-associated angiogenesis is an attractive approach to cancer therapy. To test this concept, we recombined the extracellular domains of porcine endoglin, and used it as a xenogeneic vaccine. We found that immunotherapy with porcine endoglin was effective at both protective and therapeutic anti-tumor immunity in several mouse tumor models. Autoantibodies against mouse endoglin were identified by Western blot and ELISA. IgG1 and IgG2b were substantially increased. Anti-endoglin antibody-producing B cells were detectable by ELISPOT assay. There was endothelial deposition of immunoglobulins within tumors. The anti-tumor activity was also induced by the adoptive transfer of the purified immunoglobulins. Angiogenesis was apparently inhibited within the tumor tissues and on the alginate beads. The increased apoptotic cells were found within the tumor tissues from the mice treated with porcine endoglin. The anti-tumor activity and production of autoantibodies against mouse endoglin could be abrogated by depletion of CD4(+) T lymphocytes. Remarkably, no marked toxicity was found in the immunized mice. These observations may provide an alternative rational strategy for active cancer immunotherapy.     

Novel control system for blood glucose using a model predictive method

We developed a novel blood glucose control system, using a model predictive method, to achieve optimal control of the blood glucose level in severely diabetic or pancreatectomized patients. This system is designed to predict glucose level changes in advance, considering delayed response time and the administered doses of insulin. This method is also designed to calculate the most appropriate insulin infusion rate by considering differences in individual response to insulin. In this study, we compared our system with a conventional proportional and differential controller (PD controller) to determine whether the new system could regulate the glucose level efficiently in pancreatectomized dogs. The model predictive control method resulted in a significant reduction of mean insulin infusion rate compared with the conventional PD controller (0.71 mU/kg per min vs. 1.81 mU/kg per min, p = 0.0005), when the glucose level in both methods reached the planned target level (100 mg/dl). The new system also tended to have a reduced mean glucose infusion rate for compensating for overshooting of the glucose level compared with the PD controller (0.7 mg/kg per min vs. 1.1 mg/kg per min, p = 0.16). These results indicate that the new system should be a useful tool for regulating the glucose level in severely diabetic patients.     

Drug-eluting stenting for femoropopliteal lesions,followed by cilostazol treatment,reduces stent restenosis in patients with symptomatic peripheral artery disease

Background

Cilostazol improves clinical endovascular therapy outcomes for femoropopliteal (FP) lesions in patients with symptomatic peripheral arterial disease, but whether it also has clinical benefits for patients after drug-eluting stent implantation remains unclear.

Molecular pathology quality control in Southeast Asia: Results of a multiregional quality assurance study from MASTER KEY Asia

Tissue specimen quality assurance is a major issue of precision medicine for rare cancers. However, the laboratory standards and quality of pathological specimens prepared in Asian hospitals remain unknown. To understand the methods in Southeast Asian oncology hospitals and to clarify how pre-analytics affect the quality of formalin-fixed paraffin-embedded (FFPE) specimens, a questionnaire surveying pre-analytical procedures (Part I) was administered, quality assessment of immunohistochemistry (IHC) staining and DNA/RNA extracted from the representative FFPE specimens from each hospital (Part II) was conducted, and the quality of DNA/RNA extracted from FFPE of rare-cancer patients for genomic sequencing (Part III) was examined. Quality measurements for DNA/RNA included ΔΔCt, DV200, and cDNA yield. Six major cancer hospitals from Malaysia, Philippines, and Vietnam participated. One hospital showed unacceptable quality for the DNA/RNA assessment, but improved by revising laboratory procedures. Only 57% (n = 73) of the 128 rare-cancer patients' specimens met both DNA and RNA quality criteria for next-generation sequencing. Median DV200 was 80.7% and 64.3% for qualified and failed RNA, respectively. Median ΔΔCt was 1.25 for qualified and 4.89 for failed DNA. Longer storage period was significantly associated with poor DNA (fail to qualify ratio = 1579:321 days, p < 0.001) and RNA (fail to qualify ratio = 1070:280 days, p < 0.001). After improvement of pre-analytical factors, the qualification rate increased for hospitals A and E from 41.5% to 70.5% and 62.5% to 86%, respectively. This is the first report to elucidate the pre-analytical laboratory procedures of main Southeast Asian oncology hospitals. An external quality assessment program may improve factors associated with tumor FFPE specimen quality.     

铁路女职工生殖健康状况及对心理健康的影响

目的了解铁路行业女职工生殖健康状况,探讨生殖健康对心理健康影响的危险因素,为制定铁路行业女职工劳动保护规定提供科学参考。方法采用整群抽样方法,选取济南、南宁、青藏、武汉铁路系统女职工作为研究人群,采用统一编制调查表,用Epidata3.1软件建立数据库,SPSS22.0软件进行统计处理。结果铁路女职工常见妇科疾病患病率为28.5%,发病前两位的是子宫肌瘤、阴道炎,主要发病年龄36~45岁;月经异常率20.4%,主要表现为经量异常和周期紊乱。单因素分析发现,阴道炎、外阴瘙痒和白带增多与心理健康问题有关。多因素Logistic分析发现,月经异常以及外阴瘙痒或白带增多是影响心理健康的生殖道疾患危险因素。结论建议采取积极有效的健康促进措施,增强铁路女工的自我保健意识和技能,及早治愈生殖系统疾病;同时,采取心理干预措施,减轻心理压力,缓解职业紧张。     

Laparoscopic complete mesocolic excision via combined medial and cranial approaches for transverse colon cancer

Purpose

To evaluate the safety and feasibility of laparoscopic complete mesocolic excision via combined medial and cranial approaches with three-dimensional visualization around the gastrocolic trunk and middle colic vessels for transverse colon cancer.

Methods

We evaluated prospectively collected data of 30 consecutive patients who underwent laparoscopic complete mesocolic excision between January 2010 and December 2015, 6 of whom we excluded, leaving 24 for the analysis. We assessed the completeness of excision, operative data, pathological findings, length of large bowel resected, complications, length of hospital stay, and oncological outcomes.

Results

Complete mesocolic excision completeness was graded as the mesocolic and intramesocolic planes in 21 and 3 patients, respectively. Eleven, two, eight, and three patients had T1, T2, T3, and T4a tumors, respectively; none had lymph node metastases. A mean of 18.3 lymph nodes was retrieved, and a mean of 5.4 lymph nodes was retrieved around the origin of the MCV. The mean large bowel length was 21.9 cm, operative time 274 min, intraoperative blood loss 41 mL, and length of hospital stay 15 days. There were no intraoperative and two postoperative complications.

Conclusion

Our procedure for laparoscopic complete mesocolic excision via combined medial and cranial approaches is safe and feasible for transverse colon cancer.

     

Renal simplicity denervation reduces blood pressure and renal injuries in an obesity‐induced hypertension dog model

This study aimed to investigate the effects of renal sympathetic denervation (RDN) on blood pressure, renal function, and renal tissue pathological changes in obesity‐induced hypertensive dogs. Thirty‐two beagle dogs (10‐12 months) were randomized to the control (n=10) and model groups (n=22). High‐fat diet (HFD) was used to establish the obesity‐induced hypertensive model. After 3 months of HFD, 20 animals with successfully induced hypertension were randomized to the RDN (n=10) and sham groups (n=10). Renal artery angiography, body weight, blood pressure, heart rate (HR), and blood and urine biochemistry were determined 1, 3 and 6 months after surgery. Models were killed 6 months after surgery. Pathological changes in the renal artery and renal tissue were assessed. The HFD group had significantly (P<.05) increased body weight, HR, and blood pressure, and higher levels of urine albumin, serum noradrenaline, and angiotensin II compared with controls. After RDN, blood pressure was decreased compared with baseline and the sham group (P<.05). In the RDN group, examination of the renal artery and renal tissue showed intact intima of renal artery in the surgical area, renal sympathetic nerve degeneration, necrosis, and dissolution, and widened space between nerve fibres. Hypertension‐induced renal pathological changes were mild to moderate in the RDN group, but severe in the sham group. The control group had normal glomerular structure. In conclusion, RDN can effectively lower blood pressure in obesity‐induced hypertensive dogs, as well as hypertension‐induced renal pathological changes.