Second‐look endoscopy after endoscopic submucosal dissection for gastric neoplasms

Routine second‐look endoscopy after gastric endoscopic submucosal dissection (ESD) remains controversial. The aim of the present study was to systematically evaluate the efficacy of second‐look endoscopy for gastric ESD. PubMed, the Cochrane library, and the Igaku‐chuo‐zasshi database were searched in order to identify randomized trials eligible for inclusion in the systematic review. Data were combined to calculate a pooled odds ratio (OR) for developing post‐ESD bleeding. The database search yielded three randomized trials (854 patients). Compared with second‐look endoscopy, the pooled OR for post‐ESD bleeding without second‐look endoscopy was 0.69 (95% confidence interval [CI]: 0.38–1.26, P = 0.228), without significant heterogeneity. There were no significant differences between second‐look endoscopy and no second‐look endoscopy with regard to large tumor size (>20 mm). This systematic review and meta‐analysis showed that second‐look endoscopy had no advantage for the prevention of post‐ESD bleeding in patients without a high risk of bleeding.     

Interrelation between protein kinase C and nitric oxide in the development of vasospasm after subarachnoid hemorrhage

Abstract

This study was undertaken to investigate how protein kinase C (PKC) and nitric oxide (NO) interact to regulate the vascular tone, and how their interaction contributes to the development of vasospasm after subarachnoid hemorrhage (SAH). For these purposes, vasospasm was conducted with a canine model. We investigated the following subjects with arteries from intact animals and those from the SAH model[ and compared the results between the two; tension at rest of isometric tension study, the effect of PKC inhibitors and of an inhibitor of NO synthesis on the tension at rest, and levels of guanosine 3’,5’-cyclic monophosphate (cCMP) as an indicator of NO production. The tension at rest was enhanced in the artery from the SAH model compared to that from intact animals, and it was PKC-dependent. Arteries from intact animals but not those from the SAH model developed tonic tensions by NO inhibitors, and these tonic tensions were suppressed by PKC inhibitors, and also by cGMP. An enzyme immunoassay revealed a decreased cGMP level in the SAH model.

The evidence indicates that NO exerts a negative feedback control on PKC activation. Subarachnoid hemorrhage interferes with this feedback control[ resulting in PKC-dependent enhanced vascular tone and vasospasm. [Neurol Res 1996; 18: 89–95]     

Risk factors in securing successful surgical resection of oral squamous cell carcinoma

The purpose of this retrospective study was to analyze the factors that had a significant effect on securing a successful surgical resection (surgical margin) in oral cancer surgery. One hundred forty-eight consecutive patients who underwent planned radical resection of oral squamous cell carcinoma (SCC) were analyzed. Successful resection was judged if pathological examination of the surgical specimen revealed a clear surgical margin (no SCC within 5 mm, n = 116), while an unsuccessful resection was judged if there was a close and involved surgical margin (SCC within 5 mm, n = 21; and SCC at margin, n = 11). Univariate analyses showed that gender, age, and T-classification had significant influence on successful surgical resection. The results of multivariate logistic regression analysis showed that age (odds ratio [OR] = 1.042, 95% CI = 1.001-1.084), T-classification (OR = 1.656, 95% CI = 1.060-2.587), and the presence of preoperative treatment (OR = 2.868, 95% CI = 1.047-7.85) had significant effects on successful surgical resection. The results of this study suggested that successful resection of oral SCC was difficult in patients with either older age or advanced (T4) tumor. It is also suggested that preoperative therapy had a positive effect on securing a pathologically clear surgical margin.     

Clinical usefulness of serum pyridinoline cross-linked carboxyterminal telopeptide of type I collagen for diagnosis of bone metastases in patients with primary lung cancer

OBJECTIVE: Recently, various blood and urine markers of bone metabolism have been developed and applied to the diagnosis of bone metastases. However, the cut-off values for each parameter have not yet been completely defined. In this study, the usefulness of serum pyridinoline cross-linked carboxyterminal telopeptide of type I collagen (I CTP) was assessed for detecting bone metastases from primary lung cancer and the most efficient cut-off value for I CTP based on the receiver operating characteristic curve was calculated. METHODOLOGY: Over a 1-year period, serum I CTP and serum alkaline phosphatase (ALP) were assayed for 87 primary lung cancer patients, including 21 bone metastases-positive cases at Nagoya Ekisaikai Hospital, Nagoya, Japan. RESULTS: I CTP was significantly higher in patients with bone metastases than in the group without bone metastases. In contrast, there was no significant difference in serum ALP between the two groups. The most efficient cut-off value for I CTP computed in this study was 6.4 ng/mL. This was higher than the recommended value (4.5 ng/mL) based on the data from the summated values obtained for lung cancer, breast cancer and prostate cancer, as well as the maximum value for healthy controls (4.9 ng/mL). CONCLUSION: These results suggest that measurement of serum I CTP is a useful test for diagnosing bone metastases from lung cancer. Each type of cancer has a different pattern of bone turnover at the site of bone metastases. Considering that lung cancer mainly metastasizes to bone in an osteolytic pattern, it is proposed to set a higher cut-off value for lung cancer patients than the currently recommended value.     

Osteoclastic function is accelerated in male patients with type 2 diabetes mellitus: the preventive role of osteoclastogenesis inhibitory factor/osteoprotegerin (OCIF/OPG) on the decrease of bone mineral density

To clarify the pathogenesis of altered bone metabolism in diabetic state and its underlying mechanisms, the bone mineral content and fasting levels of serum intact parathyroid hormone (i-PTH), intact osteocalcin (i-OC), tartrate-resistant acid phosphatase (TRAP) and osteoclastgenesis inhibitory factor/osteoprotegerin (OCIF/OPG) were measured in male type 2 diabetic patients and their age-matched controls. In addition, urine levels of osteoclastic markers, C-telopeptide of type I collagen (CTx), deoxypyridinoline (DPD), and N-telopeptide of type I collagen (NTx) were simultaneously determined. Serum levels of i-PTH and i-OC in diabetic patients were significantly lower than those in the controls. Conversely, serum concentrations of TRAP were significantly elevated in diabetic patients. However, no clear correlation was observed between serum i-OC and TRAP. It was also observed that urinary excretion of CTx, DPD, and NTx was significantly increased in the diabetics as compared with the controls. Unexpectedly, serum levels of OCIF/OPG tended to be higher in the diabetic group, and these values exhibited a significantly positive correlation with those of serum TRAP. There was found a significantly negative correlation between serum TRAP and bone mineral density (BMD) and also between serum OCIF/OPG and bone mineral density. It seems probable that OCIF/OPG has a suppressive role on the increased bone resorption to prevent further loss of the skeletal bone mass in type 2 diabetic patients.