[Preoperative chemotherapy enabled radical resection of tumors in a patient with multiple liver metastases].

The patient was a 61-year-old man with a prominent epigastric mass and dull pain. Sigmoid colon cancer and multiple hepatic metastases were diagnosed upon examination. The liver metastases were adjacent to the right hepatic artery and the portal vein; therefore, the patient received preoperative bevacizumab+XELOX (capecitabine plus oxaliplatin) chemotherapy. After 6 courses of chemotherapy, a sufficient partial response (PR) was achieved to secure a surgical margin during radical resection of the tumors. The patient is alive, without recurrence, 10 months after surgery. This report highlights the importance of securing a surgical margin during conversion therapy and reviews evidence from previous literature reports.

[Intraoperative complications and short-term outcomes of total laparoscopic distal gastrectomy (TLDG) for gastric cancer].

In recent years there has been an increase in the number of laparoscopic surgeries for gastric cancer, with over 8,000 cases reported nationwide in 2012. To date, we have performed 420 total laparoscopic distal gastrectomy (TLDG) procedures. In all cases, the mean operative time was 304 minutes, intraoperative bleeding was at 52 g, 30 lymph nodes were dissected, and the length of postoperative hospital stay was 10.6 days, on average. We experienced 5 intraoperative complications and 13 postoperative complications. Of 4 patients, there were 2 cases of postoperative recurrence in liver metastases, 1 case of metastatic lung tumor, and 1 case of peritoneal metastasis. Based on surgical outcomes, TLDG is a safe and feasible procedure for gastric cancer.

[Laparoscopic total colectomy (TPC) for familial adenomatous polyposis - a case report].

A 30-year-old man was admitted with anemia. Colonoscopy showed diffuse small polyps in the colon, 1 cancer in the sigmoid colon, and 2 cancers in the rectum. He was diagnosed with familial adenomatous polyposis (FAP). Total colectomy was conducted laparoscopically through 5 trocars, and a total proctocolectomy (TPC ) was performed. The operating time was 9 hours and 30 minutes, and intraoperative blood loss was 20 g. On the 1st postoperative day, he started oral intake. On the 14th postoperative day, he was discharged from our hospital. We thus consider laparoscopic resection to be a very useful technique for FAP.

[A patient with advanced gastric cancer who responded to neoadjuvant S-1 plus cisplatin chemotherapy].

The patient was a 49-year-old man who was diagnosed as having gastric cancer and was suspected of having lymph node metastasis on computed tomography( CT) scans. He received neoadjuvant chemotherapy with S-1 and cisplatin (CDDP). He underwent total gastrectomy after 2 courses of neoadjuvant chemotherapy. The pathological effect was Grade 1b. The patient was treated with oral S-1 as postoperative adjuvant chemotherapy on an outpatient basis, and there are no signs of recurrence as of 3 years and 10 months after surgery.

Self-reported seafood intake and atopy in Japanese school-aged children.

BACKGROUND: The effects of fish consumption and n-3 poly-unsaturated fatty acid (PUFA) levels on atopic disorders are inconsistent in previous reports, but few studies have investigated the effects of both fish and n-3 PUFA. The aim of the present study was to investigate whether erythrocyte fatty acids and the consumption of fish are associated with atopic diseases in pre- and early adolescents. METHODS: A total of 135 students with eczema, 136 students with asthma, and 137 healthy control students were selected from fifth and eighth grades in Shunan, Japan. Atopic disorders and dietary intake were evaluated with questionnaires, and total serum IgE was measured using an enzyme-linked immunosorbent assay. In addition, erythrocyte membrane levels of PUFA were assessed via gas chromatography. RESULTS: Total IgE was significantly elevated in the atopic subjects (P < 0.001). The intake of fatty and dried fish or seafood was significantly associated with eczema (odds ratios of the highest quartiles: 0.46, 95% confidence interval (95%CI): 0.22-0.94; 0.34, 95%CI: 0.16-0.71, respectively). Additionally, only erythrocyte eicosapentaenoic acid (EPA) level had a negative association with eczema (P= 0.048). For asthma, the effect of fish consumption was not significant. CONCLUSIONS: Fish consumption was related to a low prevalence of eczema, but not asthma in Japanese pre- and early adolescents. EPA may be involved in this mechanism.

Amount of operative blood loss affects the long-term outcome after liver resection for hepatocellular carcinoma.

BACKGROUND/AIMS: Numerous prognostic factors for HCC have been reported. Few literatures have reported clinical significance of amount of intraoperative blood loss (ABL) for the outcome after surgery for HCC. The aim of this study is to analyze the significance of ABL for outcome after surgery for HCC. METHODOLOGY: A total of 301 patients who underwent liver resection for HCC between January 1998 and June 2007 were included. Clinical and surgical characteristics were collected and prognostic factors were identified using univariate and multivariate analysis. RESULTS: Impaired liver function (liver damage B), large tumor (>36mm), multiple tumors, existence of macroscopic vessel invasion, large ABL (=700mL) and replacement of red blood cells were identified as independent prognostic factors for overall survival (OS). For disease free survival (DFS), old age (>66), male gender, impaired liver function, large tumor, multiple tumors, existence of macroscopic vessel invasion and large ABL were extracted. Limited to the patients without blood transfusion, large ABL is associated with poor OS and DFS. CONCLUSIONS: Large ABL could result in poor OS and DFS after liver resection of HCC in patients without blood transfusion. Surgeons have to make the best effort to reduce ABL.

Portal vein embolization can prevent intrahepatic metastases to non-embolized liver.

BACKGROUND/AIMS: To determine the efficacy of portal vein embolization (PVE) against unresectable hepatocellular carcinoma (HCC). METHODOLOGY: We conducted a comparative study using 17 patients with HCC determined to be unresectable and who received a combination of PVE and transarterial chemoembolization (TACE) (PVE group) and 22 HCC patients with tumors in the unilateral lobe, which were treated only with repeated TACE (TACE group) from January 2000 to December 2008. RESULTS: There were no significant differences in background factors except for gender between the two groups. The cumulative intrahepatic recurrence rates in the non-portal-embolized area (in the contralateral lobe for the TACE group) at 1 year and 3 years was 41.1% and 58.8% in the PVE group and 77.3% and 81.8% in the TACE group, respectively. The former was significantly lower (p<0.05). The cumulative overall survival rate at 1 year, 3 and 5 years was 88.2%, 38.2% and 38.2% in the PVE group, and 68.1%, 22.7% and 8.5% in the TACE group, respectively. The former was significantly higher (p<0.05). CONCLUSIONS: Although in patients with unresectable HCC, when HCC is localized in the portal-embolized area, PVE combined with TACE can prevent intrahepatic metastasis to the non-portal-embolized area and improve overall survival.

Liver hanging maneuver decreases blood loss and operative time in a right-side hepatectomy.

BACKGROUND/AIMS: To clarify the clinical benefits of the maneuver in right-side hepatectomy. METHODOLOGY: Eighty-one patients with liver tumor (54 hepatocellular carcinoma, 17 metastatic liver tumor and 10 other tumors) treated with a right-side hepatectomy were prospectively analyzed. The patients were divided into the following three groups: a conventional approach (group A, n=21); liver dissection under the hanging maneuver after liver mobilization (group B, n=19) and liver dissection under the hanging maneuver prior to liver mobilization (group C, n=41). RESULTS: The liver hanging maneuver was safely performed in all the patients in groups B and C. Tumor size had a significantly positive correlation with the amount of intraoperative blood loss (R=0.52, p<0.05) in group A only. The patients in groups B and C had a significantly lower intraoperative use of blood loss (both p<0.01), operation time (p<0.05 and p<0.01) and the frequency of blood product (both p<0.05), in comparison to group A, respectively. The postoperative morbidity and the mortality rates were similar in the three groups. CONCLUSIONS: Liver hanging maneuver is a safe procedure, which can decrease intraoperative blood loss and administration of blood product in right-side hepatectomy.

Meat intake frequency and anemia in Japanese children and adolescents.

The consumption of meat products is considered to be a feasible solution to prevent anemia, which is a critical health problem. The present study assessed hematological parameters and the prevalence of anemia in Japanese children and adolescents, and examined the association with the frequency of meat intake. Data from the Shunan Children Health Cohort Study were analyzed. The participants included male and female residents, 3373 children (aged 10-11 years), and 3085 adolescents (aged 13-14 years). The frequency of meat intake was determined with a questionnaire, and blood samples were analyzed. Anemia was defined according to the criteria of the World Health Organization. The prevalence of anemia in children was 3.6% and 2.5% in girls and boys, respectively, and in adolescents, it was 4.5% in girls and 0.8% in boys. The frequency of meat intake did not show a positive association with the hematological indices or the prevalence of anemia. These results suggest that the promotion of meat consumption is not an effective strategy to decrease anemia, and that other approaches are necessary to prevent anemia in this population.

Breakfast habits among adolescents and their association with daily energy and fish, vegetable, and fruit intake: a community-based cross-sectional study.

OBJECTIVES: To investigate breakfast eating habits on daily energy and fish, vegetable, and fruit intake in Japanese adolescents. METHODS: This study was completed as part of the Shunan Child Health Cohort Study. Two types of questionnaires, one on lifestyle habits and the other a brief-type, self-administered questionnaire on diet history, were administered to second-year junior high school students (1,876 boys and 1,759 girls) in Shunan City, Yamaguchi, Japan. The different breakfast habits were compared using the general linear model and the estimated means and P value for trend were calculated, with energy-adjusted food intake as the dependent variable and body mass index, gender, age, residential areas, and living status as covariates. RESULTS: In both males and females, the proportion of those who ate breakfast irregularly was about 10%. The daily intake of fish, vegetables, and fruit was significantly higher in those who ate breakfast with their guardians than in those who ate breakfast alone (P for trend <0.01). The daily intake of fish, seafood, and vegetables was significantly higher in those who less frequently ate cooked foods for breakfast (P for trend <0.01). Those who ate rice more frequently than bread at breakfast had a higher daily intake of fish, seafood, and vegetables (P for trend <0.01). CONCLUSIONS: Eating breakfast with the family, reducing the intake of cooked foods at breakfast, and eating breakfast with rice as a main staple food are suggested to contribute to an improved quality of diet in adolescents.

Preoperative portal vein embolization (PVE) for patients with hepatocellular carcinoma can improve resectability and may improve disease-free survival.

BACKGROUND: The aim of this study is to identify the efficacy of portal vein embolization (PVE) before right hepatectomy in patients with hepatocellular carcinoma (HCC) with regard to hepatic function, surgical stress, and survival benefit. METHODS: Fifty-five patients with HCC underwent right hepatectomy between 1999 and 2009. Preoperative PVE was performed in 19 patients (PVE group) and was not applied in 36 patients (non-PVE group). Changes in liver function and volume were investigated in PVE group. Short and long clinical outcomes after the surgeries were compared between the two groups. RESULTS: The percentage of future liver remnant (%FLR) before PVE was significantly lower (37.8%) in PVE group than in non-PVE group (58.1%) but increased remarkably after PVE (from 37.8% to 55.0%, P < 0.0001). Cumulative disease-free survival and overall survival rates in PVE group were significantly superior to those in non-PVE group (P = 0.010 and 0.049, respectively). Although surgical stress estimated by E-PASS scores and CRP value was not different between the groups, the postoperative value of PT on postoperative day 3 in PVE group was significantly better than in non-PVE group. CONCLUSIONS: Preoperative PVE improves resectability and may improve disease-free survival for patients with HCC requiring right hepatectomy.

Primary neuroendocrine tumor in the liver treated by hepatectomy: report of a case.

A 49-year-old woman was admitted to our hospital under suspicion of an enlarging hepatic tumor, which had been previously diagnosed to be a cavernous hemangioma. Computed tomography revealed three enhanced tumors, one measuring 15 cm in diameter within the right lobe of the liver and two intrahepatic metastases in Couinaud's hepatic segments 3 and 5. We diagnosed the patient to have primary liver cancer, and suspected a combined liver tumor preoperatively. We performed a right trisectionectomy with radiofrequency ablation of the intrahepatic metastasis in S3. According to the immunohistochemical findings of the resected specimen and the findings of postoperative imaging studies, the tumor was diagnosed to be a primary neuroendocrine tumor in the liver. The patient is presently alive without recurrence at 33 months after the operation.

Evaluation of the usefulness of cystic duct three-dimensional computed tomography with non-contrast for before laparoscopic cholecystectomy and endoscopic transpapillary gallbladder drainage in comparison to magnetic resonance cholangiopancreatography.

INTRODUCTION: The purpose of this study is to evaluate whether anatomical variations of the cystic duct and accessory bile duct can be grasped by cystic duct three-dimensional (3D)-computed tomography (CT) using non-contrast CT and to examine the possibility of omitting magnetic resonance cholangiopancreatography (MRCP). METHODS: Of patients who underwent non-contrast abdominal CT between May and October 2019, those who underwent MRCP within 1 month before and afterwards were targeted. Seven assessors visually evaluated the cystic duct 3D-CT images on a 5-point scale. Average scores of ≥3 and <3 points were assigned as the good and poor groups, respectively. Regions of interest (ROIs) were placed inside the cystic duct and four places around it, and the CT values in those ROIs were measured. The CT value difference was calculated by subtracting the surrounding CT values from the CT value in the cystic duct and converting the result to an absolute value. The CT value difference was classified into good and poor groups, and statistical analysis was performed. Seven assessors evaluated anatomical variations of the cystic duct and the presence of the accessory bile duct. The results were compared with the MRCP interpretation results to calculate sensitivity, specificity, positive predictive value, and negative predictive value. RESULTS: The average visual evaluation score was 3.8. The good and poor groups were comprised by 53 (85.5%) and 9 (14.5%) patients, respectively. The CT difference value averages were 54.7 and 15.9 for the good and poor groups, respectively, and the value was significantly higher in the good group (p = 0.001). The comparison results with MRCP were sensitivity=83.3%, specificity=78.0%, positive predictive value=47.6%, and negative predictive value=95.1%. CONCLUSION: Cystic duct 3D-CT using non-contrast CT is a useful technique for understanding anatomical variations of the cystic duct and accessory bile duct. Our method may reduce the number of MRCP sessions performed.

Association of serum carotenoids and tocopherols with atopic diseases in Japanese children and adolescents.

The present study assessed whether serum carotenoids and tocopherols are associated with atopic diseases (eczema and asthma) in 10- and 13-yr-olds in a Japanese community. Of 2796 students attending schools in Shunan, Japan, in 2006, 396 students were randomly selected for this study using nested case-control design. Atopic diseases and dietary food intake were assessed using self-administered questionnaires, and serum antioxidants were analyzed using high-performance liquid chromatography. We found no associations between serum carotenoids and atopic diseases. However, odds ratios (OR)s for the third and fourth quartiles of serum alpha-tocopherol with atopic eczema were 0.33 (95% confidence interval: 0.15-0.73) and 0.36 (0.14-0.89), respectively, and the trend was negatively significant (P(trend) = 0.048). We did not find a significant association for asthma. In conclusion, serum alpha-tocopherol was negatively associated with the prevalence of eczema. Serum carotenoids did not show definitive protective effects in Japanese youth.

Use of body mass index and percentage overweight cutoffs to screen Japanese children and adolescents for obesity-related risk factors.

BACKGROUND: Cutoffs based on percentage overweight (POW) are used for screening students in Japan; however, body mass index (BMI) is more common in the rest of the world. To screen for risk factors related to obesity among Japanese primary and secondary school students, we compared fasting and postprandial values, and the receiver operating characteristic (ROC) curves for the POW and BMI criteria. METHODS: The subjects were students aged 10 and 13 years living in Shunan City, Japan between 2006 and 2008 (n = 6566). POW and International Obesity Taskforce (IOTF) BMI criteria were used to screen for obesity-related risk factors. The lower (20%, 18-year-old equivalent: 25 kg/m(2)) and higher (50%, 18-year-old equivalent: 30 kg/m(2)) cutoffs were examined, and ROC curves were drawn. RESULTS: Fasting cholesterol levels were higher than postprandial levels. The prevalences of overweight/obesity were 6.6% to 10.0% using the lower cutoff and 0.6% to 5.0% using the higher cutoff. Among overweight subjects under fasting conditions, dyslipidemia was present in 12% to 52%, hypertriglyceridemia in 29% to 54%, hyperglycemia in 11% to 21%, and hypertension in 15% to 40%. Although the use of the lower and higher POW cutoffs resulted in lower sensitivity and the higher specificity, the POW and BMI ROC curves largely overlapped. However, for girls aged 10 years, the POW curve for >or=3 risks factors was lower than that of the latter (P = 0.013). CONCLUSIONS: For Japanese aged 10 and 13 years, both BMI and POW are useful for risk factor screening. However, subjects may be misclassified with dyscholesterolemia if postprandial blood samples are used.

[An elderly patient with advanced gastric cancer maintaining complete response for over 3 years by oral administration of UFT following short span of S-1].

We report a successful case of chemotherapy with oral fluoropyrimidines. The patient was an 81-year-old woman who complained epigastric discomfort. Endoscopy revealed a type 3 advanced gastric cancer, and the biopsy specimen was defined histologically as poorly-differentiated adenocarcinoma. She didn't hope for an operation, but agreed to receive chemotherapy. S-1 (80 mg/day) was administered for 14 days, followed by 7 days rest. This schedule induced grade 1 thrombocytopenia and fatigue after two weeks administration. Therefore, we reduced the administration dosage to 60 mg/ day. Almost complete response (CR) was observed after 8 weeks of S-1 administration. But she was admitted urgently to other emergency hospital for stumbling due to dizziness accompanied with vomiting and anorexia. We considered it was difficult to continue S-1 administration. Therefore, we changed S-1 to UFT-E and started from 300 mg/day. One month later, as the adverse effects were not recognized, we increased a dosage of UFT-E to 400 mg/day for the purpose of more dose intensity. After 6 months, CR was confirmed continuously. We reduced UFT-E to 300 mg/day, and CR has been continued for 3 years until now without any adverse events. There was no evidence regarding the best timing to syop anticancer administration. As the adverse effect was very mild and her quality of life improved, we continued UFT-E administration for a long time.

Measuring methods for functional reach test: comparison of 1-arm reach and 2-arm reach.

UNLABELLED: Kage H, Okuda M, Nakamura I, Kunitsugu I, Sugiyama S, Hobara T. Measuring methods for functional reach test: comparison of 1-arm reach and 2-arm reach. OBJECTIVES: To investigate which functional reach test better reflects the center of pressure excursion, a 1-arm reach or a 2-arm reach, and to investigate the effect of trunk rotation on the reach distance in a 1-arm reach. In addition, we considered the influence of the individual variation at the starting position. DESIGN: Descriptive study using a force platform and a 3-dimensional (3D) motion capture system. SETTING: Motion analysis laboratory in a college setting. PARTICIPANTS: Elderly volunteers (N=41; 15 men, 26 women; 71.8+/-5.2y). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: 3D coordinate data and the movement of the center of pressure. RESULTS: The correlation between the reach distance and the center of pressure excursion was significantly higher (P<.05) for the 1-arm reach (r=.60, .72) compared with a 2-arm reach (r=.41, .55). In the case of the 1-arm reach, center of pressure excursion was a significant factor affecting reach distance (beta=.319, .470) in multivariate regression analysis, but trunk rotation was not (beta=.162, .095). When the reach distance was measured using the heel as a reference, the correlation was stronger. CONCLUSIONS: To evaluate dynamic balance, a 1-arm reach, which better reflects center of pressure excursion, is more valid. It is meaningful to reduce the individual variation of the acromion at the starting position.

Role of the loop structure of the catalytic domain in rice class I chitinase.

In the three-dimensional structure of a rice class I chitinase (OsChia1b) determined recently, a loop structure (loop II) is located at the end of the substrate-binding cleft, and is thus suggested to be involved in substrate binding. In order to test this assumption, deletion of the loop II region from the catalytic domain of OsChia1b and replacement of Trp159 in loop II with Ala were carried out. The loop II deletion and the W159A mutation increased hydrolytic activity not only towards (GlcNAc)6 but also towards polysaccharide substrates. Similar results were obtained for kcat/Km values determined for substrate reduced-(GlcNAc)5. The two mutations shifted the splitting positions in (GlcNAc)6 to the reducing end side, but the shift was less intensive in the Trp mutant. Theoretical analysis of the reaction time course indicated that sugar residue affinity at the +3 subsite was reduced from -2 kcal/mol to +0.5 kcal/mol by loop II deletion. Reduced affinity at the +3 subsite might enhance the release of product fragments, resulting in higher turnover and higher enzymatic activities. Thus, we concluded that loop II is involved in sugar residue binding at the +3 subsite, but that Trp159 itself appears to contribute only partly to sugar residue interaction at the subsite.

Conformal radiation therapy for portal vein tumor thrombosis of hepatocellular carcinoma.

BACKGROUND AND PURPOSE: The prognosis of patients with portal vein tumor thrombosis (PVTT) from hepatocellular carcinoma (HCC) is poor; without treatment, their survival is less than 3months. We retrospectively evaluated the treatment outcomes of conformal radiation therapy (CRT) in patients with HCC-PVTT. MATERIALS AND METHODS: Thirty-eight HCC patients with PVTT in whom other treatment modalities were not indicated underwent CRT. The total dose was translated into a biologic effective dose (BED) of 23.4-59.5Gy(10) (median 50.7Gy(10)) as the alpha/beta ratio=10. Predictive factors including the age, performance status, Child-Pugh classification, PVTT size, and BED were evaluated for tumor response and survival. RESULTS: Complete response (CR), partial response (PR), stable disease (SD), and progressive disease (PD) were observed in 6 (15.8%), 11 (28.9%), 17 (44.7%), and 4 (10.5%) patients, respectively. The response rate (CR+PR) was 44.7%. The PVTT size (<30 vs. 30mm) and BED (<58 vs. 58Gy(10)) were significant factors for tumor response. The median survival and 1-year survival rate were 9.6months and 39.4%. The Child-Pugh classification (A vs. B) and BED were significant factors for survival. CONCLUSIONS: CRT is effective not only for tumor response but also for survival in HCC-PVTT patients in whom other treatment modalities are not indicated.