Usefulness of the one-step technique in functional end-to-end anastomosis for colonic surgery: results of a prospective multicentre cohort study from the Japanese KYCC group.

BACKGROUND: Although functional end-to-end anastomosis (FEEA) using a stapler in the colorectal field has been recognised worldwide, the technique varies by surgeon, and the safety of anastomosis using different techniques is unknown. METHODS: This multicentre prospective observational cohort study was conducted by the KYCC Study Group in Yokohama, Japan, and included patients who underwent colonic resection at seven centres between April 2020 and March 2022. This study compared the incidence of surgery-related abdominal complications (SAC: anastomotic leakage [AL], anastomotic bleeding, intra-abdominal abscess, enteritis, ileus, surgical site infection, and other abdominal complications) between two different methods of FEEA (one-step [OS] method: simultaneous anastomosis and bowel resection; two-step [TS] method: anastomosis after bowel resection). Complications of Clavien-Dindo classification grade 2 or higher were assessed. RESULTS: Among 293 eligible cases, the OS and TS methods were used in 194 (66.2%) and 99 (33.8%) patients, respectively. The baseline characteristics were similar between the groups. The OS method used fewer staplers (three vs. four staplers, p < 0.00001). There were no significant differences in SAC rate between the OS (19.1%) and the TS (16.2%) groups (p = 0.44). The OS group had four cases (2.1%) of AL (two patients; grade 3, two patients; grade 2) while the TS group had one case (1.0%) of grade 2 AL (p = 0.67). Multivariate logistic regression analysis showed that male sex (odds ratio [OR] 3.95; p < 0.00001), an open surgical approach (OR 2.36; p = 0.03), and longer operative duration (OR,2.79; p = 0.002) were independent predictors of complications, whereas the OS method was not an independent predictor (OR 1.17; p = 0.66). CONCLUSIONS: The OS and the TS technique for stapled colonic anastomosis in a FEEA had a similar postoperative complication rate. TRIAL REGISTRATION NUMBER: UMIN000039902 (registration date 23 March 2020).

Evaluation of vascular anatomy for colon cancer located in the splenic flexure using the preoperative three-dimensional computed tomography angiography with colonography.

PURPOSE: The aim of this study is to reveal the vascular branching variation in SFC (splenic flexure cancer) patients using the preoperative three-dimensional computed tomography angiography with colonography (3D-CTAC). METHODS: We retrospectively analyzed patients with SFC who underwent preoperative 3D-CTAC between January 2014 and December 2019. RESULTS: Among 1256 colorectal cancer (CRC) patients, 96 (7.6%) manifested SFC. The arterial branching from the superior mesenteric artery (SMA) was classified into five patterns, as follows: (type 1A) the left branch of middle colic artery (LMCA) diverged from middle colic artery (MCA) (N = 47, 49.0%); (2A) the LMCA diverged from the MCA and the accessory middle colic artery (AMCA) (N = 26, 27.1%); (3A) the LMCA independently diverged from the SMA (N = 16, 16.7%); (4A) the LMCA independently diverged from the SMA and AMCA (N = 3, 3.1%); (5A) only the AMCA and the LMCA was absent (N = 4, 4.1%). Venous drainage was classified into four patterns, as follows: (type 1V) the SFV flows into the inferior mesenteric vein (IMV) then back to the splenic vein (N = 50, 52.1%); (2V) the SFV flows into the IMV then back to the superior mesenteric vein (SMV) (N = 19, 19.8%); (type 3V) the SFV independently flows into the splenic vein (N = 3, 3.1%); (type 4V) the SFV is absent (N = 24, 25.0%). CONCLUSION: 3D-CTAC could reveal accurate preoperative tumor localization and vascular branching. These classifications should be helpful in performing accurate complete mesocolic excision and central vessel ligation for SFC.

Comparison of neuronal activity in the supplementary motor area and primary motor cortex.

Neuronal activity in the supplementary motor area (SMA) and primary motor cortex (MI) have been compared in many experiments during performance of many different motor tasks. On one hand, the activity in both areas may appear similar, especially when the motor task is simple. On the other hand, if the motor tasks are more demanding, neuronal activity in the SMA exhibits a variety of complex relationship to many different aspects of motor behavior, while the activity in MI is mostly related to execution of motor task itself. Of particular interest is the neuronal activity in the SMA during preparation and execution of motor tasks when no external cues for the retrieval of appropriate motor act is available. Temporal sequencing of multiple movements is a typical example of the kind of motor task that requires profound activity in the SMA.

Visually based path-planning by Japanese monkeys.

To construct an animal model of strategy formation, we designed a maze path-finding task. First, we asked monkeys to capture a goal in the maze by moving a cursor on the screen. Cursor movement was linked to movements of each wrist. When the animals learned the association between cursor movement and wrist movement, we established a start and a goal in the maze, and asked them to find a path between them. We found that the animals took the shortest pathway, rather than approaching the goal randomly. We further found that the animals adopted a strategy of selecting a fixed intermediate point in the visually presented maze to select one of the shortest pathways, suggesting a visually based path planning. To examine their capacity to use that strategy flexibly, we transformed the task by blocking pathways in the maze, providing a problem to solve. The animals then developed a strategy of solving the problem by planning a novel shortest path from the start to the goal and rerouting the path to bypass the obstacle.

Microstimulation of the supplementary eye field during saccade preparation.

Electrical stimulation of the supplementary eye field (SEF) of monkeys has been reported to evoke saccades with low threshold currents. In previous reports, the evoked saccades have appeared either as 'converging', 'goal directed', or at times 'constant vector'. In the present study, a new aspect of intracortical microstimulation (ICMS) was found when the stimulus was applied at the time when an animal was prepared to initiate its own voluntary saccades. A cue signal was given to the animal that indicated targets of impending saccades. After a variable delay period, a 'go' signal told the monkey to initiate the saccade toward the target. ICMS was applied shortly (50-100 ms) before the go signal. The stimulus-evoked saccades were directed toward and captured the cued target, provided that the target direction was contralateral to the cortical stimulus site. Saccades with that property were evoked only from a limited portion of the cortical field that corresponded to the SEF, characterizing this particular oculomotor area.

Activity of digital area neurons of the primary somatosensory cortex in relation to sensorially triggered and self-initiated digital movements of monkeys.

Single-cell activity was examined in digital areas of the primary somatosensory cortex (SI) of monkeys performing sensorially triggered and self-initiated digital movements with the aim of rigorously determining the relative timing of onset of the neuronal activity with respect to movement onset. The activity of prime mover muscles for execution of a key-press movement was recorded simultaneously with the neuronal activity; movement onset was defined as the onset of muscle activity. Neuronal receptive fields were also identified. The following findings emerged from this study: (1) Few neurons, if any, in the SI(areas 3b, 1, 2), including pyramidal tract neurons, were active prior to movement onset. (2) The movement-related activity of SI neurons was basically similar in cases of signal-triggered and self-initiated movement. (3) No neuron in the SI showed activity associated with ipsilateral digital movement. (4) A majority of movement-related neurons in the precentral motor cortex, in contrast, started their activity before movement onset. These findings suggest that SI neuronal activity participates little in providing information necessary for developing motor responses in the initial phase of simple digital movements.

Slow fluctuations of single unit activities of hippocampal and thalamic neurons in cats. II. Role of serotonin on the stability of neuronal activities.

A series of experiments was carried out both in the hippocampal pyramidal and thalamic ventrobasal neurons to investigate the effect of serotonin level in the brain on slow fluctuations of neuronal discharges. Single neuronal activities were recorded in the following two pharmacologically treated states: (1) a 5-hydroxytryptamine depleted state by p-chlorophenylalanine administration (PCPA phase) and (2) a 5-methoxy-N,N-dimethyltryptamine administered state under the PCPA pretreatment (5-MeODMT phase). The slow fluctuations of neuronal activities in the frequency range of 0.02-1.0 Hz in both nuclei were prominent during the PCPA phase and were similar to those during the paradoxical sleep. In contrast, slow fluctuations were suppressed during the 5-MeODMT phase and neuronal activities during this phase were similar to those during slow wave sleep (SWS). The results show that serotonin in the brain definitely plays a role in stabilizing single neuronal activities.

Markov-dependency and spectral analyses on spike-counts in mesencephalic reticular neurons during sleep and attentive states.

Spontaneous activities of the mesencephalic reticular formation (MRF) neurons of head-restrained cats were recorded to investigate their dynamic properties during sleep and waking. The Markov-dependency and spectral analyses were performed on the time series of counts converted from the MRF spike-train. During slow-wave sleep (SWS), MRF neurons fired with low Markovian properties and had a similar spectral-density curve as white noise; during paradoxical sleep (PS), their firing pattern showed high Markovian properties owing to low-frequency fluctuations, with spectral densities inversely proportional to frequency (the l/f spectrum). During the attentive state of bird watching (BW), intermediate Markovian properties were observed. These results confirmed both the rest theory of SWS and the activation of the brain during PS from the viewpoint of dynamic information-processing. Furthermore, the activation of the brain during PS may be greater than in BW.

Slow fluctuations of single unit activities of hippocampal and thalamic neurons in cats. I. Relation to natural sleep and alert states.

Spontaneous unit discharges during the natural sleep-wakefulness cycle in two different neuronal groups, the hippocampal pyramidal cells and thalamic ventrobasal neurons, have been analyzed. The results show that both neurons fire with white-noise-like fluctuations during the slow-wave sleep, and with slow fluctuations with power spectral densities inversely proportional to the frequency in the frequency range of 0.02-1.0 Hz, during the paradoxical sleep. This confirms that the characteristics of fluctuations in neuronal activities of the mesencephalic reticular formation observed in our previous study are more general phenomena in the cat's brain. Partly similar behavior of spectral densities is also observed during the alert state. These observations are quantitatively confirmed by the statistical time series analysis of the spike density processes of spontaneous activities.

[A case of video-assisted thoracic surgery for congenital esophago-bronchial fistula].

A 42-year-old male was admitted to our hospital because barium esophagograpm showed an esophago-bronchial fistula with an esophageal deverticulum. He has had frequent episodes of cough at drinking water since childhood. A chest CT scan showed mild inflammatory change and bronchiectasis in the right S6. Division of the fistula by video-assisted thoracoscopic surgery (VATS) was performed. There was no evidence of inflammation and adherent lymph nodes around the fistula. This case was diagnosed as a congenital esophago-bronchial fistula by operative findings and clinical course. The fistula was dissected easily and divided by an auto-suturing instrument. The affected lung could be preserved. The patient was discharged on the 10th postoperative day. VATS is an effective treatment for the patients of congenital esophago-bronchial fistula (Braimbrige type I and II), if they are not accompanied with pulmonary abscess or pleural empyema.

[Evaluation of new drug delivery system for primary lung cancer: intermittent intra-arterial injection therapy with implantable port system (reservoir)--II. Evaluation of technical methods for cannulation of feeding arteries of lung cancer with implantation of implantable port system].

As mentioned in the first of the present series of reports, lung cancers were fed by various arteries such as bronchial arteries, internal mammary arteries, inter-costal arteries and branches of subclavian arteries such as thyro-cervical truncus or thoraco-dorsal arteries, according to the size and stages of tumors and the processes of therapy. On the basis of these anatomical findings of the feeders of lung cancers, we tried several effective and reasonable ways of cannulation of catheters, which were connected with an implantable port system.

[Evaluation of new style of drug delivery system for primary lung cancer: intermittent intra-arterial injection therapy with subcutaneous infusible port I.--Temporary changes in feeding arteries of lung cancer in processes of intra-arterial injection therapy].

Arterial injection therapy for lung cancers is concentrated on the bronchial arteries, because they are reported by the main feeders of lung cancers. In the present study, we attempted intermittent arterial injection therapy with implantable port system. In the cases of lung cancers, in the present study, tumors were mainly fed by bronchial arteries originating from intercostal-bronchial arteries in right lungs, and those directly originating from aorta in the left lungs. However, in the processes of BAI (Bronchial Arterial Injection Therapy), main feeders often were obstructed and the new feeders originated from branches of subclavian arteries, such as thyro-cervical truncks, internal mammary arteries, thoraco-acromial arteries and intercostal arteries. They formed networks surrounding the lungs. Adequate study of the feeding arteries should be performed in the course of arterial injection therapy of lung cancers.

Multiple optical stimulation to neuron using Si opto-neural probe with multiple optical waveguides and metal-cover for optogenetics.

We have developed a Si opt-neural probe with multiple waveguides and metal cover for highly accurate optical stimulation. This neural probe had 16 recording sites, three optical waveguides, and metal cover for suppressing light leakage. We evaluated electrochemical properties of the recording sites, and confirmed that the neural probe had suitable characteristics for neural recording. We also demonstrated the optical stimulation to the neurons expressing ChR2 using our probe. As a result, we succeeded multisite optical stimulation, and observed that no light leakage from the optical waveguides because of the metal cover. From in vivo experiments, we successfully recorded optically modulated local field potential using the fabricated Si neural probe with optical waveguides. Moreover, we applied current source density analysis to the recorded LFPs. As a result, we confirmed that light induced membrane current sink in locally stimulated area. Our Si opto-neural probe with multiple optical waveguides and metal-cover is one of the most versatile tools for optogenetics.

Cancer gene therapy using a novel secretable trimeric TRAIL.

Tumor necrosis factor (TNF)-related apoptosis-inducing ligand (TRAIL), a member of the TNF family, is a type II transmembrane cytokine molecule. Soluble TRAIL has been shown to induce apoptosis in a wide variety of cancer cells in vitro and to suppress tumor growth specifically without damaging normal cells and tissues in vivo. In our previous report, we have demonstrated that an artificial gene encoding the polypeptide composed of the three functional elements (a secretion signal, a trimerization domain and an apoptosis-inducing moiety of TRAIL gene sequence) expresses and secretes highly apoptotic trimeric TRAIL into the culture supernatant. Here, as an approach to TRAIL-based cancer gene therapy, we developed an adenoviral vector delivering the gene that encodes our secretable trimeric TRAIL (stTRAIL). This adenovirus (Ad-stTRAIL) potently induced apoptosis in vitro in cancer cell lines such as HeLa, MDA-MB-231, A549, HCT116 and U-87MG. In an animal xenograft tumor model bearing a human glioma cell line U-87MG, intratumoral delivery of Ad-stTRAIL dramatically suppressed tumor growth without showing detectable adverse side effects. Histological analysis revealed that Ad-stTRAIL suppresses tumor growth by inducing apoptotic cell death. Contrary to the known rapid clearance of systemically delivered TRAIL protein from the blood circulation, stTRAIL expressed by Ad-stTRAIL in tumor tissues persisted for more than 4 days. In a comparison of tumor suppressor activity between Ad-stTRAIL and Ad-flTRAIL (delivering the full-length TRAIL gene) after mixing infected cells with uninfected cells and implanting these mixed cells in nude mice, Ad-stTRAIL showed higher tumor suppressor activity than that of Ad-flTRAIL. Our data reveal that a gene therapy using Ad-stTRAIL has a promising potential to treat human cancers including gliomas.

Neuronal activity in the ventral part of premotor cortex during target-reach movement is modulated by direction of gaze.

We recorded 200 neurons from the ventral part of the premotor cortex (PMv) and 110 neurons from the primary motor cortex (MI) of a monkey performing a visually cued arm-reaching task with a delay. We compared neuronal activity in the premovement period while the monkey reached the target with the eyes fixating on either a left or right fixation target. Our data demonstrate that about half of the movement-related activity in the PMv was modulated by the direction of gaze. In contrast, a vast majority of the activity of MI neurons and about half of PMv neurons were not influenced by the direction of gaze. We further analyzed the movement-related activity during the reaching movement to targets at the top, bottom, left, and right of each fixation point. The magnitude of activity of neurons showing the gaze-direction selectivity was primarily determined by the position of the reaching target relative to the eye-fixation target, and not by the position of the target relative to the animal's body. These data suggest that a part of the coordinate transformation of the motor command signals concerning the direction of reaching from the retinotopic to body-centered frame of reference may occur at the level of premotor cortex but not in MI.