High-risk Patients With Colorectal Liver Metastases Assessed by the Beppu Score Can Have Excellent Survival Through Multidisciplinary Treatment Including Local Ablation.

BACKGROUND/AIM: The Beppu score assessed by the Japanese Society of Hepato-Biliary-Pancreatic Surgery nomogram helps predict postoperative disease-free survival for patients with resectable colorectal liver metastases (CRLM). Using the Beppu score, patients with resectable CRLM were divided into three groups according to recurrence risk: low (≤6 points), moderate (7-10 points), and high-risk (≥11 points). Hepatectomy following preoperative chemotherapy is recommended for high-risk patients. The surgical outcome, local recurrence rates, and long-term survival were assessed, focusing on local ablation. PATIENTS AND METHODS: Twenty high-risk and unresectable CRLM patients were enrolled between April 2016 and April 2022. Hepatectomy with or without local ablation was performed after induction chemotherapy. Local ablation was permissive for patients with effective chemotherapy (partial response and stable disease) with CRLM ≤2 cm and ≥5 mm distant from major vessels. RESULTS: The median diameters and numbers of CRLM were 26 (10-150) mm and 9 (1-46). All 18 patients who received preoperative chemotherapy were disease controls. Local ablation was performed simultaneously on hepatectomy in 14 patients. The median diameters and numbers of the ablated nodules were 12 (5-17) mm and 3 (1-21). Local recurrence was 8.5% per 82 ablative nodules. Three-year disease-free and five-year overall survival was 57.4% and 56.2%, respectively. There was no significant difference in patients with or without local ablation. CONCLUSION: Our treatment strategy for high-risk CRLM patients is feasible and can provide an excellent long-term prognosis regardless of adding local ablation to hepatectomy.

Huge hepatocellular carcinoma with extrahepatic collateral arteries successfully treated by multidisciplinary treatment including laparoscopic devascularization: a case report.

Multidisciplinary treatment is recommended for the management of patients with advanced hepatocellular carcinoma (HCC). Some operative decollateralization of extrahepatic feeding arteries with laparotomy have been introduced for HCC. We herein newly develop laparoscopic devascularization (LDEV) to continue transarterial chemoembolization (TACE) for HCC with extrahepatic collateral arteries. A 74-year-old man with multiple huge HCC (4 tumors, 18 cm in diameter) and poor liver function (non-alcoholic steatohepatitis, Child-Pugh score 7) was treated with 6 times of chemoembolization in combination with LDEV, 3 times of ablation therapies, and lenvatinib therapy. His tumor markers were triple positive (AFP, 12,906.5 ng/ml; PIVKA-II, 491,743 mAU/ml; AFP-L3, 91.8%) before treatments; however, they all returned to normal limits. Complete response was achieved according to the modified RECIST criteria. Unfortunately, he died 6 months after the final treatment with no recurrence of HCC due to the postoperative complication of primary lung cancer. LDEV is a useful tool to continue effective TACE, and multidisciplinary treatment including chemoembolization and LDEV can cure advanced HCC patients with extrahepatic collaterals and impaired liver function.

Insemination rates of hybrids between Culex pipiens pipiens and Culex pipiens quinquefasciatus or Culex pipiens pallens at high temperature.

Females of Culex pipiens pallens are rarely inseminated at temperatures above 30 degrees C. Insemination and egg-hatching rates (F2) were examined in females of hybrids (F1) between Culex pipiens pipiens and Culex pipiens quinquefasciatus at 25 degrees C and 30 degrees C to examine temperature-dependent reproductive activity. Insemination rates were very high in hybrid females (F1) at 25 degrees C and 30 degrees C, and egg-hatching rate (F2) also was high at both temperatures. Crosses between Cx. p. pipiens and Cx. p. quinquefasciatus did not show insemination rates and egg-hatching rates similar to the rates observed in Cx. p. pallens, suggesting that the hybrids expressed reproductive activity characteristic of Cx. p. quinquefasciatus.

Effects of mating on oogenesis induced by amino acid infusion, amino acid feeding, or blood feeding in the mosquito Anopheles stephensi (Diptera: Culicidae).

Hemocoel infusion of an amino acid mixture at a concentration of 7.5% and 10% (wt:vol) for 24 h rarely activated ovarian development in either mated or unmated females of Anopheles stephensi Liston. Infusion of either concentration mixture for 48 h into unmated females was also scarcely stimulatory, but the same 48 h infusion into mated females resulted in ovarian maturation in 25% (7.5% mixture) or in 78% (10% mixture) of the infused specimens. Similarly, feeding on an amino acid mixture (7.5%) containing sugar induced 44% ovarian maturation among mated females, while only 3% of unmated females showed matured oocytes. The increase of hemolymph amino acid concentration levels may be one of the essential factors for oogenesis of An. stephensi, and mating enhances ovarian development, especially in females ingesting poor meals. However, some additional factor(s) may be included for full development comparable to that induced by blood meals.

Reproductive activity and survival of Culex pipiens pallens and Culex quinquefasciatus (Diptera: Culicidae) in Japan at high temperature.

The egg hatchability, insemination, and longevity of Japanese Culex pipiens pallens Coquillett and Japanese Culex quinquefasciatus Say were compared at 25 and 30 degrees C. Egg hatchability was high in Cx. p. pallens at 25 degrees C, but it was very low at 30 degrees C because almost no females were inseminated at this temperature. In Cx. quinquefasciatus, the egg hatchability and insemination rates were very high, even at 30 degrees C. The longevity of adult females and males was generally shorter in Cx. p. pallens than in Cx. quinquefasciatus at both temperatures. Because high temperatures may restrict the spread of Cx. p. pallens, we suggest that even if this species spreads to Okinawa, the possibility of it becoming established is very low.

Ovarian development induced in decapitated female Culex pipiens pallens mosquitoes by infusion of physiological quantities of 20-hydroxyecdysone together with amino acids.

Infusion of 20-hydroxyecdysone into the hemocoel of unfed decapitated female Culex pipiens pallens mosquitoes, at a very low rate of 500-2000pg per day, often stimulated oögenesis of this species, when the hormone was infused together with amino acids. The hormone alone or amino acids alone showed no such stimulatory effect. Previous reports that using an abdomen ligated immediately after a blood meal for hormone injection reduced the quantity of 20-hydroxyecdysone needed to activate unfed female Aedes aegypti by a few thousand times, are therefore due mainly to a sufficient supply of amino acids from the midgut in the isolated abdomen.