Head-Tilt Perfluorocarbon-Air Exchange Technique With Heads-Up Surgery for Giant Retinal Tear-Associated Retinal Detachments to Prevent Retinal Slippage Without Using Silicone Oil.

PURPOSE: To report the efficacy of the perfluorocarbon liquid-air exchange with a head tilt toward the area of the giant retinal tear (GRT) using the heads-up surgery system to prevent retinal slippage during vitrectomy for GRT-associated retinal detachments. METHODS: Eyes with GRT-associated retinal detachments underwent vitrectomy using the heads-up surgery system and perfluorocarbon liquid-air exchange with a head tilt 45° toward the GRT to put the area of the tear in the most dependent position to drain fluid. This technique was evaluated to prevent retinal slippage. RESULTS: Five consecutive cases were evaluated. The mean GRT size was 174° (range, 90-240°) and the GRT was located temporally in two eyes, nasally in two eyes, and superiorly in one eye. The tamponade types were air (1 eye), sulfur hexafluoride (3 eyes), and perfluoropropane (1 eye). Our technique was feasible and the slippage did not occur in any eyes. Although the microscope needed to be tilted for optimal fundus visualization, heads-up surgery allowed surgeons to maintain ergonomic postures. Retinal reattachment was achieved with a single surgery in all eyes. CONCLUSION: The head-tilt perfluorocarbon liquid-air exchange with heads-up surgery is useful in preventing retinal slippage in eyes with GRT.

Fungicide Resistance of Alternaria alternata and A. arborescens Isolates from Mandarin Fruit and Its Influence on Control of Postharvest Alternaria Rot.

Alternaria rot, caused by Alternaria alternata and A. arborescens, is one of the common postharvest diseases affecting mandarin fruit in California. Fungicide resistance profilings of A. alternata and A. arborescens to quinone outside inhibitors (QoIs), fludioxonil, pyrimethanil, imazalil, and propiconazole were examined in this study. Of the 100 isolates of A. alternata and A. arborescens, 40 were identified as resistant to QoI fungicides according to a PCR-restriction fragment length polymorphism based on a cytochrome b partial gene. Effective concentrations of fludioxonil that caused a 50% reduction in fungal growth relative to the control (EC50) were 0.089 ± 0.020 and 0.101 ± 0.032 µg/ml for 43 A. alternata and 19 A. arborescens isolates, respectively. EC50 values of pyrimethanil, imazalil, and propiconazole for the 70 A. alternata isolates tested were 0.373 ± 0.161, 0.492 ± 0.133, and 1.135 ± 0.407 µg/ml, respectively. EC50 values of pyrimethanil, imazalil, and propiconazole for 30 A. arborescens isolates were 0.428 ± 0.190, 0.327 ± 0.180, and 0.669 ± 0.452 µg/ml, respectively. Control tests on mandarin fruit inoculated with representative isolates of both species showed that fludioxonil, pyrimethanil, imazalil and propiconazole significantly reduced disease incidence and severity. Azoxystrobin significantly reduced Alternaria rot severity and incidence on mandarin fruit inoculated with sensitive isolates but not with resistant isolates, regardless of Alternaria spp. There were no significant differences in Alternaria rot control effectiveness if treatment with any of the fungicides tested was delayed after inoculation by 6 or 12 h. These results could help in the development of postharvest fungicide programs to control Alternaria rot on mandarin fruit during storage.

Fungicide Resistance and Host Influence on Population Structure in Botrytis spp. from Specialty Crops in California.

Botrytis is an important genus of plant pathogens causing pre- and postharvest disease on diverse crops worldwide. This study evaluated Botrytis isolates collected from strawberry, blueberry, and table grape berries in California. Isolates were evaluated for resistance to eight different fungicides, and 60 amplicon markers were sequenced (neutral, species identification, and fungicide resistance associated) distributed across 15 of the 18 B. cinerea chromosomes. Fungicide resistance was common among the populations, with resistance to pyraclostrobin and boscalid being most frequent. Isolates from blueberry had resistance to the least number of fungicides, whereas isolates from strawberry had resistance to the highest number. Host and fungicide resistance-specific population structure explained 12 and 7 to 26%, respectively, of the population variability observed. Fungicide resistance was the major driver for population structure, with select fungicides explaining up to 26% and multiple fungicide resistance explaining 17% of the variability observed. Shared and unique significant single-nucleotide polymorphisms (SNPs) associated with host and fungicide (fluopyram, thiabendazole, pyraclostrobin, and fenhexamid) resistance-associated population structures were identified. Although overlap between host and fungicide resistance SNPs were detected, unique SNPs suggest that both host and fungicide resistance play an important role in Botrytis population structure.

Fungicide Resistance in Alternaria alternata from Blueberry in California and Its Impact on Control of Alternaria Rot.

Alternaria rot caused by Alternaria alternata is one of the major postharvest diseases affecting blueberries in California. The sensitivity profiles of A. alternata from blueberry field to quinone outside inhibitors (QoIs), boscalid, fluopyram, fludioxonil, cyprodinil, and polyoxin D in California were examined in this study. EC50 values of 51 A. alternata isolates for boscalid varied greatly among the isolates, ranging from 0.265 to >100 µg/ml. EC50 values of 51 A. alternata isolates to fluopyram, fludioxonil, cyprodinil, and polyoxin D were 5.188 ± 7.118, 0.078 ± 0.021, 0.465 ± 0.302, and 6.238 ± 7.352 µg/ml, respectively. In total, 143 isolates were screened for resistance at 5 and 10 µg/ml for fludioxonil, cyprodinil, and fluopyram, 10 µg/ml for polyoxin D, and 10 and 50 µg/ml for boscalid. Based on the published discriminatory concentrations for phenotyping resistance, of the 143 isolates, all were considered resistant to boscalid; 32, 69, and 42 were sensitive, low resistant, and resistant to fluopyram, respectively; and all were sensitive to fludioxonil and cyprodinil. In a PCR-restriction fragment length polymorphism method for phenotyping, 60 out of the 143 isolates were classified as resistant to QoIs. Control tests on detached blueberry fruit inoculated with different Alternaria isolates showed that fludioxonil and cyprodinil significantly reduced disease incidence and severity; however, pyraclostrobin, boscalid, fluopyram, and polyoxin D significantly reduced only disease severity. The obtained results will be helpful in making decisions on fungicide programs to control A. alternata isolates with resistance or reduced sensitivities to multiple fungicides.

Effects of Peroxyacetic Acid on Postharvest Diseases and Quality of Blueberries.

Postharvest diseases are a limiting factor in the storage of fresh blueberries. Gray mold caused by Botrytis cinerea and Alternaria rot caused by Alternaria spp. are important postharvest diseases in blueberries grown in California. Control of these fungal pathogens is generally dependent on preharvest sprays of synthetic fungicides, but in California multiple fungicide resistance has already developed in those pathogens, leading to the failure of disease control. Therefore, alternatives to synthetic fungicides are needed for the control of postharvest diseases. Peroxyacetic acid (PAA) is a disinfectant agent that poses low risk to human health. In this study, we evaluated the effects of postharvest use of PAA at 24 µl liter-1 and 85 µl liter-1 on fruit decay caused by fungal pathogens and quality of stored blueberry fruit. PAA treatment was applied to four cultivars over three seasons using two methods, dipping or spraying. Dipping blueberries compared with spraying them with PAA and its application at 85 µl liter-1 were the most effective treatments. For example, when applied to 'Snowchaser' blueberries, this combination reduced naturally occurring decay after 4 weeks of storage at 0 to 1°C from 14.3% among water-treated controls to 2.7% in 2018, and from 25.7% among water-treated controls to 8.6% in 2020. In general, PAA did not adversely affect fruit quality or sensory quality of blueberries. Postharvest use of PAA appears to be a promising means to reduce postharvest decay of blueberries. To reliably obtain an acceptable level of disease control, the best use of PAA may be in combination with other practices rather than using it alone.

Phylogenetic, Morphological, and Pathogenic Characterization of Alternaria Species Associated With Fruit Rot of Mandarin in California.

Alternaria rot caused by Alternaria species is one of the major postharvest diseases of mandarin fruit in California. The aims of this study were to identify these Alternaria species via phylogenetic analyses and morphological characteristics and test their pathogenicity on mandarin. Decayed mandarin fruits exhibiting Alternaria rot symptoms were collected from three citrus fruit packinghouses in the Central Valley of California. In total, 177 Alternaria isolates were obtained from decayed fruit and preliminarily separated into three groups representing three species (A. alternata, A. tenuissima, and A. arborescens) based on the colony characterization and sporulation patterns. To further identify these isolates, phylogenetic analysis was conducted based on DNA sequences of the second largest subunit of RNA polymerase II (RPB2), plasma membrane ATPase (ATPase), and Calmodulin gene regions in combination with morphological characters. Of the 177 isolates, 124 (70.1%) were identified as A. alternata, and 53 (29.9%) were A. arborescens. The isolates initially identified as A. tenuissima based on the morphological characteristics could not be separated from those of A. alternata in phylogenetic analysis and thus considered A. alternata. Pathogenicity tests showed that both Alternaria species were pathogenic on mandarin fruit at both 5°C and 20°C. Our results indicated that two Alternaria species, A. alternata and A. arborescens, were responsible for Alternaria rot of mandarin fruit in California, with A. arborescens causing fruit rot on mandarin being reported for the first time.

Baseline Sensitivity of Alternaria alternata and A. arborescens to Natamycin and Control of Alternaria Rot on Stored Mandarin Fruit.

Alternaria rot caused by Alternaria alternata and A. arborescens is one of the major postharvest diseases on mandarin fruit in California. In this study, natamycin, a newly registered biofungicide, was evaluated for its potential as a postharvest treatment to control Alternaria rot on mandarin fruit. The baseline sensitivities of A. alternata and A. arborescens to natamycin were determined. Effective concentration inhibiting 50% of fungal growth (EC50) values of natamycin for 70 A. alternata isolates ranged from 0.694 to 1.275 µg/ml (mean = 0.921 µg/ml) in a conidial germination assay and from 2.001 to 3.788 µg/ml (mean = 2.797 µg/ml) for 40 A. alternata isolates in a mycelial growth assay. EC50 values of natamycin for 30 A. arborescens isolates ranged from 0.698 to 1.203 µg/ml (mean = 0.923 µg/ml) in a conidial germination assay and from 2.035 to 3.368 µg/ml (mean = 2.658 µg/ml) for 20 A. arborescens isolates in a mycelial growth assay. Control tests on detached mandarin fruit showed that natamycin at both low (460 µg/ml) and high (920 µg/ml) recommended rates significantly reduced disease incidence and severity on mandarin fruit inoculated with Alternaria isolates, regardless of species. High rate of natamycin significantly reduced disease incidence and severity compared with the nontreated control even when natamycin treatment was delayed for 6, 12, and 18 h after inoculation. Our results suggested that natamycin can be an effective postharvest fungicide for control of Alternaria rot on mandarin fruit.

Population Genetics and Fungicide Resistance of Botrytis cinerea on Vitis and Prunus spp. in California.

Botrytis cinerea, the causal agent of gray mold, has high genetic diversity and a broad host range. In Vitis sp. and Prunus spp., B. cinerea causes pre- and postharvest diseases, and fungicides are routinely applied to prevent yield loss. In total, 535 isolates of B. cinerea collected from Vitis sp. and Prunus spp. in 2012, 2016, and 2017 were genotyped using 18 microsatellite markers and the transposable elements (TEs) Boty and Flipper. Only nine of the polymorphic markers and the two TEs were considered informative and retained for the final analyses. Of the 532 isolates, 297 were tested for resistance to seven fungicides representing six Fungicide Resistance Action Committee classes. After clone correction, 295 multilocus genotype groups were retained across the 3 years in 326 individuals, and four genetic subpopulations were detected. High levels of clonality were observed across the dataset. Significant pairwise differentiation was detected among years, locations, and TE composition. However, most of the diversity observed was within a subpopulation and not among subpopulations. No genetic differentiation was detected among resistant and sensitive isolates for individual fungicide classes. When resistance to the total number of fungicides was compared, regardless of the fungicide class, significant differentiation was detected among isolates that are resistant to two fungicide classes and those resistant to three or four fungicide groups. Fungicide resistance frequencies were stable for most chemistries evaluated with the exception of fluopyram, which increased from 2012 to 2016/2017.

Diverse genetic variation in maternal lineages with high heterogeneity among in situ-conserved wild rice (Oryza rufipogon Griff.) developed in Thailand.

Wild rice, Oryza rufipogon, is a genetic resource that can be used to improve cultivated rice, but its populations are now decreasing in terms of both size and number. Extensive research on wild rice has been conducted in Thailand, where two in situ conservation sites have been preserved in natural areas where perennial wild rice predominates. The genetic structure of wild rice populations was investigated by examining both the chloroplast and nucleus genomes at sites of in situ conservation site in Thailand. One accession from an in situ-conserved site was re-sequenced against the chloroplast genome of O. sativa cv. 'Nipponbare' to develop chloroplast insertion/deletion (cpINDEL) markers. These cpINDEL markers revealed unique maternal lineages in the in situ-conserved populations upon comparison with other Asian wild rice accessions. Diverse genetic variation was also detected with SSR markers throughout the genome. Three populations differed from each other and also within single populations. The sub-populations within an in situ-conserved population showed a complex population structure due to their multiple maternal lineages and relatively higher number of haplotypes when they maintained a relatively large population size. Such a heterogeneous population would serve as a unique gene pool for rice breeding.

[A Case of Mixed Adenoneuroendocrine Carcinoma(MANEC)of the Duodenum with Rapid Liver Metastases after Pancreatoduodenectomy].

A 62-year-old man presented at our hospitalwith generalfatigue and tarry stool. Gastrointestinalendoscopy revealed a tumor in the first portion of the duodenum. Histologically, biopsy specimens indicated adenocarcinoma, and a subtotal stomach- preserving pancreatoduodenectomy was performed. The finalhistol ogicaldiagnosis was mixed adenoneuroendocrine carcinoma(MANEC)of the duodenum. Liver metastases appeared rapidly within 3 months after surgery. We report on the management of a rare case of MANEC in the duodenum.

[Jejunal duplication in an adult presenting with hematochezia].

A 56-year-old man was admitted to our hospital with appetite loss, palpitations, orthostatic syncope, and hematochezia. Contrast-enhanced abdominal computed tomography (CT) revealed a proximal jejunal diverticulum with contrast extravasation. We immediately performed transoral double balloon enteroscopy (DBE) to treat the bleed in the jejunum, and this revealed a small ulcer with an exposed vessel at the opening of the jejunal diverticulum. Hemostasis was achieved endoscopically with argon plasma coagulation (APC) and hemoclips. During subsequent surgery, the diverticulum was found on the mesenteric side of the jejunum. We performed laparoscopy-assisted partial resection of the jejunum, and pathological examination showed that the diverticulum shared a common proper muscle layer with the jejunum and was covered by jejunal mucosa with no ectopic mucosa. Therefore, we diagnosed jejunal duplication. After hospital discharge, the patient had no recurrence of hematochezia or anemia. We report a rare case of jejunal duplication presenting with hematochezia, which was diagnosed as jejunal diverticular bleeding by CT and DBE before surgery. Pathological analysis confirmed jejunal duplication after surgery. We suggest that intestinal diverticular bleeding, as well as duplication of the gastrointestinal tract, should be considered as part of the differential diagnosis of obscure gastrointestinal bleeding.

Allopolyploidy and the evolution of plant virus resistance.

BACKGROUND: The relationship between allopolyploidy and plant virus resistance is poorly understood. To determine the relationship of plant evolutionary history and basal virus resistance, a panel of Nicotiana species from diverse geographic regions and ploidy levels was assessed for resistance to non-coevolved viruses from the genus Nepovirus, family Secoviridae. The heritability of resistance was tested in a panel of synthetic allopolyploids. Leaves of different positions on each inoculated plant were tested for virus presence and a subset of plants was re-inoculated and assessed for systemic recovery. RESULTS: Depending on the host-virus combination, plants displayed immunity, susceptibility or intermediate levels of resistance. Synthetic allopolyploids showed an incompletely dominant resistance phenotype and manifested systemic recovery. Plant ploidy was weakly negatively correlated with virus resistance in Nicotiana species, but this trend did not hold when synthetic allopolyploids were taken into account. Furthermore, a relationship between resistance and geographical origin was observed. CONCLUSION: The gradients of resistance and virulence corresponded to a modified matching allele model of resistance. Intermediate resistance responses of allopolyploids corresponded with a model of multi-allelic additive resistance. The variable virus resistance of extant allopolyploids suggested that selection-based mechanisms surpass ploidy with respect to evolution of basal resistance to viruses.

Selection, Fitness, and Control of Grape Isolates of Botrytis cinerea Variably Sensitive to Fenhexamid.

Of 683 Botrytis cinerea isolates collected from a fungicide-trial vineyard, 31 were classified as putatively resistant to fenhexamid (50% effective concentration [EC50] ≥ 0.1 µg/ml). For the resistant isolates that survived and sporulated in culture, colony expansion and conidial germination frequency was significantly reduced relative to the mean of 30 representative baseline isolates (EC50 = 0.03 µg/ml). Grape berries were inoculated with four isolates representing a range of fenhexamid sensitivities and treated preventively or curatively with fenhexamid concentrations (150 to 600 mg/liter) representing 25 to 100% of the recommended rate. All treatments significantly delayed disease onset and progress caused by isolates with EC50 values of 0.03 and 0.15 µg/ml but provided little to no control of isolates with EC50 values of 0.32 and 62.5 µg/ml. The latter isolate exhibited a previously unreported F427V mutation of ERG27, an enzyme of ergosterol biosynthesis. In a duplex quantitative polymerase chain reaction test, the ratio of pathogen/host DNA increased significantly for 14 days after inoculation of untreated berries with a baseline isolate but declined slightly in berries treated with fenhexamid at 600 mg/liter 1 day post inoculation. In the vineyard, disease control was affected by the number and rate of fenhexamid applications but B. cinerea isolates with EC50 ≥ 0.1 µg/ml were not preferentially selected.

Fundus examination using a wide-angle viewing system and intraocular illumination through the corneal incision during cataract surgery: a case series.

PURPOSE: To report a new technique for fundus examination using a wide-angle viewing system combined with intraocular illumination without accessing the vitreous cavity. STUDY DESIGN: Retrospective case series METHODS: Consecutive patients with atopic dermatitis-related cataracts who underwent standard cataract surgery and the novel fundus examination technique were included. After phacoemulsification, the anterior and posterior chambers were filled with ocular viscoelastic devices. A 27-gauge endo-illumination probe was inserted into the anterior chamber through a corneal incision made for cataract surgery. The fundus examination was performed with a wide-angle viewing system and scleral indentation. If any retinal breaks/detachments were detected, they were treated simultaneously. Finally, an intraocular lens was implanted. RESULTS: Ten patients (13 eyes) were included (mean age 26.8 years; 9 men). Retinal breaks were detected in 5 eyes (38%); 2 of the 5 had rhegmatogenous retinal detachment (RRD) (15%). Intraoperative cryopexy was performed for 3 eyes with retinal breaks, while 2 eyes with RRD underwent a scleral buckling procedure (SBP) during the same surgery. There were no intra- or postoperative complications, including posterior capsule damage. The average surgical time was 22 minutes for cases requiring only fundus examination and about 28 and for eyes with cryopexy and 80 minutes for SBP. CONCLUSION: The described technique may reduce the disadvantages of creating scleral incisions and provide comparable visibility to inserting the illuminator into the vitreous cavity.

Tissue acquisition for comprehensive genomic profiling of gallbladder cancer using a forward-viewing echoendoscope in a patient who underwent Roux-en-Y reconstruction.

A 50-year-old man with a history of total gastrectomy, distal pancreatectomy, splenectomy, and Roux-en-Y reconstruction was admitted to our hospital with a gallbladder tumor that had infiltrated the liver and abdominal wall. Because malignant cells were not collected during the percutaneous biopsy, we planned to perform an endoscopic ultrasound-guided fine-needle biopsy with a 22-G Franseen needle using a forward-viewing echoendoscope. Using intermittent manual compression, the forward-viewing echoendoscope reached the duodenum under fluoroscopic guidance. Endoscopic ultrasound-guided fine-needle biopsy was performed using a 22-G needle and 20-mL syringe and yielded a sufficient specimen with a single puncture. Malignant cells were promptly identified during on-site evaluation. The composition of the specimen (> 20% cancer cells and tissue area exceeding 25 mm2) enabled comprehensive genomic profiling. Subsequently, high-tumor mutational burden was diagnosed based on comprehensive genomic profiling, and pembrolizumab was initiated as a second-line therapy. Even in cases involving Roux-en-Y reconstruction, endoscopic ultrasound-guided fine-needle biopsy using a forward-viewing echoendoscope can result in collection of a high-quality specimen.

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.

Chemotherapy with bevacizumab for metastatic colorectal cancer: a retrospective review of 181 Japanese patients.

BACKGROUND: There has so far been little information on the clinical effect of bevacizumab against colorectal cancer in Japan. Hence, this study was conducted to retrospectively evaluate the safety and efficacy of bevacizumab in clinical practice. METHODS: A total of 181 patients with metastatic colorectal cancer (mCRC) received bevacizumab in combination with chemotherapy at 18 hospitals in Kumamoto prefecture, Japan. We surveyed the medical records of all patients regarding the patient characteristics, objective tumor responses, and adverse events. We analyzed their overall survival and the survival benefit when continuing the administration of bevacizumab beyond disease progression (progressive disease; PD) in patients who received bevacizumab-containing 1st line therapy. RESULTS: The response rate (RR) in all lines of therapy was 42 %. The 1st line patients showed significantly better survival in comparison to the patients who received further lines of treatment (P = 0.005). There were no significant differences in survival between the group with post-PD treatment with bevacizumab and the group with post-PD treatment without bevacizumab (P = 0.13). The most common grade 3 or greater adverse event associated with bevacizumab was hypertension (12.2 %). Especially, a high incidence of gastrointestinal (GI) perforation was shown in this study (4.4 %) and most of the patients with GI perforation had some risk factors for this complication. CONCLUSION: Although the survival benefit of bevacizumab in Japanese patients with mCRC was similar to that observed in previous clinical trials, this study showed a high incidence of GI perforation in comparison to previous studies. Therefore, the careful selection of patients with few risk factors for this complication is likely to lead to a greater benefit from bevacizumab treatment.

A case of internal hernia in the pararectal fossa.

BACKGROUND: Internal hernias are relatively rare and difficult to diagnose. Diagnostic delays lead to the progression of strangulation. In particular, pararectal fossa hernias are extremely rare. We encountered a case in which internal hernia occurred in the pararectal fossa. CASE PRESENTATION: An 87-year-old woman was referred to our hospital because of persistent lower abdominal pain and vomiting. Contrast-enhanced computed tomography revealed findings of intestinal ischemia, such as closed loop formation with reduced contrast effect on the left side of the rectum in the pelvis. Strangulation small bowel obstruction was diagnosed, and emergency laparotomy was performed. The small intestine was found to invade the peritoneal reflection on the left side of the rectum. The patient was finally diagnosed with pararectal fossa hernia. The incarcerated small intestine was released with no bowel resection. The 4-cm hernia phylum was observed and closed by simple suture. The patient had a good postoperative course without recurrence. CONCLUSIONS: We encountered a very rare case of internal hernia in the left pararectal fossa. Preoperative diagnosis of this disease is difficult, but it should nevertheless be considered in cases in which the cause of the intestinal obstruction is unknown.

MicroRNA-200b regulates cell proliferation, invasion, and migration by directly targeting ZEB2 in gastric carcinoma.

BACKGROUND: The microRNA-200 (miR-200) family has been reported to induce epithelial differentiation and suppress epithelial-mesenchymal transition (EMT) by inhibiting translation of zinc finger E-box-binding homeobox (ZEB) 1 and 2 mRNAs in several types of cancers. This study aimed to clarify the role of miR-200b in regulating EMT and promoting cellular proliferation, invasion, and migration in gastric cancer. METHODS: The relationships among the expression levels of miR-200b, ZEB1 and ZEB2, and E-cadherin mRNAs were analyzed by quantitative real-time reverse transcription-polymerase chain reaction in frozen tissue samples from 40 gastric cancer patients who underwent gastrectomy from 2008 to 2010. The effects of miR-200b on EMT in gastric cancer cells in vitro were also analyzed. RESULTS: Diffuse histologic type, depth of tumor, tumor size, lymph node metastasis, and lymphatic invasion were significantly higher in the low-miR-200b expression group compared with the high expression group. There was a strong correlation between the levels of miR-200b, and ZEB2 and E-cadherin mRNAs in gastric cancer patients. Upregulation of miR-200b in gastric cancer cells changed the cell morphology from fibroblast- to epithelial-like, associated with localization of E-cadherin to the plasma membrane. ZEB2 mRNA levels fell, while E-cadherin expression levels increased in gastric cells overexpressing miR-200b, associated with significantly reduced cellular proliferation, and inhibition of cellular migration and invasion. CONCLUSIONS: miR-200b regulates ZEB2 expression and thus controls metastasis in gastric cancer.

Usefulness of transcription-reverse transcription concerted reaction method for detecting circulating tumor cells in patients with colorectal cancer.

PURPOSE: The CellSearch system (Veridex, LLC) is useful for detecting circulating tumor cells (CTCs) in various carcinomas, including colorectal cancer (CRC); however, there are some problems associated with its clinical use. A transcription-reverse transcription concerted reaction (TRC) method, which is a PCR-based technique producing more stable and reliable results, because it is a more simplified process compared with the conventional techniques, has been introduced for detecting micrometastasis in some carcinomas. We aimed to demonstrate the effectiveness of TRC method in the CTC detection. METHODS: We compared the two methods for the sensitivity for CTC detection using the colon cancer cell line and 42 whole-blood samples from patients with advanced or metastatic CRC. Furthermore, 25 patients with metastatic CRC were enrolled to investigate the correlation between CTC detection and prognosis in both methods. RESULTS: The sensitivity of the TRC method was similar to that of the CellSearch system. The overall survival rate was significantly worse in the patients diagnosed as CTC-positive by the TRC method than in those diagnosed as CTC-negative; this finding was similar to the prognosis indicated by the CellSearch system. However, clinically, the TRC method could detect CTCs more rapidly and at a reduced cost compared with the CellSearch system. CONCLUSIONS: The TRC method seems to be a useful alternative to the CellSearch system for clinically detecting CTCs in patients with metastatic CRC.