Cribriform Subtype is an Independent Predictor of Recurrence and Survival After Adjustment for the Eighth Edition of TNM Staging System in Patients With Resected Lung Adenocarcinoma

Introduction

At present, cribriform arrangements are regarded as a pattern of acinar adenocarcinoma. However, recent studies have indicated that clinical outcomes for lung adenocarcinoma patients with cribriform subtype are unfavorable. To validate the prognostic significance of the cribriform pattern, we analyzed a series of 735 Japanese patients with resected lung adenocarcinoma, which was restaged according to the eighth edition of the TNM staging system.

Interactive scan control for kinematic study in open MRI

PURPOSE: A tool to support the subject is generally used for kinematic joint imaging with an open MRI apparatus because of difficulty setting the image plane correctly. However, use of a support tool requires a complicated procedure to position the subject, and setting the image plane when the joint angle changes is time consuming. Allowing the subject to move freely enables better diagnoses when kinematic joint imaging is performed. We therefore developed an interactive scan control (ISC) to facilitate the easy, quick, and accurate setting of the image plane even when a support tool is not used. METHODS: We used a 0.4T magnetic resonance (MR) imaging system open in the horizontal direction. The ISC determines the image plane interactively on the basis of fluoroscopy images displayed on a user interface. The imaging pulse is a balanced steady-state acquisition with rewound gradient echo (SARGE) sequence with update time less than 2 s. Without using a tool to support the knee, we positioned the knee of a healthy volunteer at 4 different joint angles and set the image plane through the patella and femur at each of the angles. Lumbar imaging is also demonstrated with ISC. RESULTS: Setting the image plane was easy and quick at all knee angles, and images obtained clearly showed the patella and femur. Total imaging time was less than 10 min, a fourth of the time needed when a support tool is used. We also used our ISC in kinematic imaging of the lumbar. CONCLUSION: The ISC shortens total time for kinematic joint imaging, and because a support tool is not needed, imaging can be done more freely in an open MR imaging apparatus.     

Tailor-made medicine in Helicobacter pylori eradication therapy

Pharmacokinetic profiles of omeprazole and lansoprazole were well correlated with the CYP2C19 genotype. The heterozygous extensive metabolizer was slightly different from the homozygote, but there was no statistically significant difference. The CYP2C19 genotype dependence found for lansoprazole was not obvious compared with omeprazole. As for rabeprazole, the pharmacokinetic profile was independent of the CYP2C19 genotype. CYP2C19 genotyping can provide a new strategy to choose an optimal regimen, and this genotyping is especially useful for Japanese, as the frequency of poor metabolizers is five times greater than that found among Caucasians. However, we should be aware that the increase of antimicrobial-resistant strains of H. pylori may force us to examine antimicrobial susceptibility of all patients in order to achieve a more than 80% eradication rate at first-line therapy in the near future. We should also have proper knowledge of the influence of the CYP2C19 genetic polymorphism on treatment efficacy according to the variety of PPI and the combination with other drugs.     

Excessive alcohol intake enhances the development of synchronous cancerous lesion in colorectal cancer patients

Background and aims We examined the potential impact of alcohol drinking on the incidence of synchronous colorectal cancer.Patients and methods This study comprised 191 men with colorectal cancer who had undergone surgical resection. Synchronous colorectal cancer was found in 16 patients (8.4%). The relationship between synchronous colorectal cancer and alcohol intake was analyzed by multivariate methods. Cumulative alcohol intake was assessed by the drinking index (weekly average multiplied by years of drinking).Results There was higher incidence of associated adenoma in the synchronous cancer group. Heavy cumulative intake (drinking index 9800 or higher) was associated with significantly higher risk synchronous colorectal cancer than in nondrinkers (odds ratio 6.8). The association of alcohol intake with the risk of synchronous colorectal cancer was not affected by the type of alcohol beverages.Conclusion This study demonstrated that excessive alcohol intake might be an independent risk factor for synchronous colorectal cancer. The screening program based on this information may prevent the synchronous lesions being missed.     

Modified laparoscopic splenectomy: a beneficial technique for ABO-incompatible living donor renal transplantation candidates on hemodialysis

Advances in laparoscopy have enabled minimally invasive surgical treatment of splenic diseases. Even with these advances, laparoscopic splenectomy in patients on dialysis can be difficult because of tissue fragility due to the underlying renal disease. We report a safe surgical technique for laparoscopic splenectomy in patients on maintenance dialysis that is suitable for use before ABO-incompatible living donor renal transplantation (LDRTx). Between June 1972 and December 2006, a total of 800 patients underwent LDRTx in our department, including 82 patients who underwent ABO-incompatible LDRTx. Between April 2001 and December 2006 we performed laparoscopic splenectomy in 48 hemodialysis patients as a pretreatment before ABO-incompatible LDRTx. Under general anesthesia the operation was performed using a new technique, referred to as the "splenic hilum lump method." We evaluated the surgical outcomes, such as the operative time, amount of blood loss, efficacy, and complications. The mean operative time was 131.6 +/- 38.4 min and mean blood loss was 126 +/- 395 mL. Blood transfusion was required in three patients. All cases had satisfactory kidney function after LDRTx and none developed kidney graft failure due to acute rejection. Almost all patients could walk the day after laparoscopic splenectomy and were satisfied with the cosmetic appearance of the scar after wound healing. The surgical technique we report here can be safely performed on patients with renal failure who require caution because of tissue fragility. Laparoscopic splenectomy is a safe, effective and less invasive operative procedure as a pretreatment for ABO-incompatible LDRTx.     

Artificial acceleration of mammalian cell reprogramming by bacterial proteins

The molecular mechanisms of cell reprogramming and differentiation involve various signaling factors. Small molecule compounds have been identified to artificially influence these factors through interacting cellular proteins. Although such small molecule compounds are useful to enhance reprogramming and differentiation and to show the mechanisms that underlie these events, the screening usually requires a large number of compounds to identify only a very small number of hits (e.g., one hit among several tens of thousands of compounds). Here, we show a proof of concept that xenospecific gene products can affect the efficiency of cell reprogramming to pluripotency. Thirty genes specific for the bacterium Wolbachia pipientis were forcibly expressed individually along with reprogramming factors (Oct4, Sox2, Klf4 and c‐Myc) that can generate induced pluripotent stem cells in mammalian cells, and eight were found to affect the reprogramming efficiency either positively or negatively (hit rate 26.7%). Mechanistic analysis suggested one of these proteins interacted with cytoskeleton to promote reprogramming. Our results raise the possibility that xenospecific gene products provide an alternative way to study the regulatory mechanism of cell identity.     

Predictive factors of postoperative diabetes insipidus in 333 patients undergoing transsphenoidal surgery for non-functioning pituitary adenoma

Pituitary - Diabetes insipidus (DI) following transsphenoidal surgery (TSS) is a common complication. Although postoperative DI often occurs in patients with craniopharyngioma and Rathke’s...     

Effect of beta-receptor blockade on the development of resistance to trauma in rats

To study the mechanisms of the development of resistance to trauma, we examined the survival of a tumbling trauma using a Noble-Collip drum (40 rpm) by rats conditioned by sublethal drummings with and without prior administration of propranolol. The drum conditioning that consisted of four consecutive sublethal drummings (200, 350, 500, and 650 revolutions) induced increased resistance to an otherwise lethal drumming (800 revolutions) in rats without pretreatment of propranolol. Rats administered with propranolol 4 mg/kg intraperitoneally (ip) prior to each sublethal drumming showed a mortality of 22% after the lethal drumming which was significantly less than the mortality of 92% in nonconditioned rats pretreated with propranolol. This increased resistance to a lethal trauma in rats conditioned by drummings with concurrent administration of propranolol was confirmed in another lot of rats. These results indicated that prior administration of propranolol 4 mg/kg ip did not inhibit the induction of trauma resistance by repeated sublethal drummings, suggesting the existence of a mechanism unaffected by this dose of propranolol.     

Recurrent Renal Hyperparathyroidism Caused by Parathyromatosis

Background Parathyromatosis is defined as multiple foci of benign hyperfunctioning parathyroid tissue in the neck or mediastinum. Parathyromatosis is a problematic cause of recurrent hyperparathyroidism (HPT). In renal HPT, the stimuli of the parathyroid cells persist after parathyroidectomy (PTx), and for this reason, parathyromatosis might be important in renal HPT. Methods Between July 1973 and December 2005, 1,932 patients underwent PTx for advanced renal HPT in our department. We evaluated the frequency, clinical findings and the prognosis of this kind of parathyroid disorder. Results After total PTx with forearm autograft for renal HPT, which was performed initially in our department, the risk for developing parathyromatosis was 0.11% (2/1837); after sub-total PTx, it was 5% (1/20). The risk for developing parathyromatosis was lower after total PTx with forearm autograft than after sub-total PTx (P < 0.05). In patients who developed persistent or recurrent HPT and were referred to our department for neck re-operation, parathyromatosis occurred in 12.1% (7/58); in those originally operated on at our hospital, the corresponding figure was 7.1% (3/42). This difference was not significant (P = 0.42). Only in 4 of 10 patients was parathyromatosis suggested before re-operation. However, in spite of several re-operations, high parathyroid hormone (PTH) levels persisted in 6 of 10 patients with parathyromatosis. Conclusion Parathyromatosis is a non-negligible cause of recurrent renal HPT in patients who require neck re-exploration. Parathyromatosis is difficult to diagnose pre-operatively and completely controlled by re-operation. Parathyromatosis should be kept in mind when performing neck re-exploration for recurrent renal HPT.     

Central action of orexins on sympathetic outflow and cardiovascular function with a focus on the paraventricular nucleus of the hypothalamus

Orexins were initially reported as regulators of food intake. More recent reports suggest that they might play roles in the multiple functions of neuronal systems, causing medical conditions such as narcolepsy, a sleep disorder. Orexins and their receptors (OX1R and OX2R) are distributed in the neural tissue and brain regions involved in the autonomic and neuroendocrine control. Within the hypothalamus, orexin fibers and orexin receptors, especially OX2R, are found extensively in the paraventricular nucleus (PVN) of the hypothalamus. The PVN is an integrative center of the autonomic nervous system and the neuroendocrine system. Thus, orexins may play a role in the regulation of cardiovascular and autonomic nervous systems. This article provides a summary of our studies, in which we used direct recording of renal sympathetic nerve and PVN neuronal activities in conscious freely-moving rats and the in vitro whole cell patch-clamp technique to examine the direct effect of orexins on PVN neurons using a hypothalamic slice. Functional studies demonstrated that intracerebroventricularly (i.c.v.) administered orexins evoke increases in blood pressure, heart rate, and sympathetic nerve activity and depolarize both the magno- and parvo-cellular neurons through the activation of non-selective cation channels. The present studies suggest that PVN plays a role as one of the efferent pathways of orexin-induced activation of the sympathetic outflow.