Multicenter prospective trial of total gastrectomy versus proximal gastrectomy for upper third cT1 gastric cancer.

BACKGROUND: The appropriate surgical procedure for patients with upper third early gastric cancer is controversial. We compared total gastrectomy (TG) with proximal gastrectomy (PG) in this patient population. METHODS: A multicenter, non-randomized trial was conducted, with patients treated with PG or TG. We compared short- and long-term outcomes between these procedures. RESULTS: Between 2009 and 2014, we enrolled 254 patients from 22 institutions; data from 252 were included in the analysis. These 252 patients were assigned to either the PG (n = 159) or TG (n = 93) group. Percentage of body weight loss (%BWL) at 1 year after surgery, i.e., the primary endpoint, in the PG group was significantly less than that of the TG group (- 12.8% versus - 16.9%; p = 0.0001). For short-term outcomes, operation time was significantly shorter for PG than TG (252 min versus 303 min; p < 0.0001), but there were no group-dependent differences in blood loss and postoperative complications. For long-term outcomes, incidence of reflux esophagitis in the PG group was significantly higher than that of the TG group (14.5% versus 5.4%; p = 0.02), while there were no differences in the incidence of anastomotic stenosis between the two (5.7% versus 5.4%; p = 0.92). Overall patient survival rates were similar between the two groups (3-year survival rates: 96% versus 92% in the PG and TG groups, respectively; p = 0.49). CONCLUSIONS: Patients who underwent PG were better able to control weight loss without worsening the prognosis, relative to those in the TG group. Optimization of a reconstruction method to reduce reflux in PG patients will be important.

Facial expression under stiff stratum corneum leads to strain concentrations, followed by residual wrinkle formation.

OBJECTIVE: Computer simulation studies of skin models, which indicate skin compression in the same manner as facial expressions, have suggested that stratum corneum could control skin-folding patterns, which may play an essential role in wrinkle formation. However, it is not clear to what extent the mechanics of stratum corneum influence wrinkle formation in vivo. The aim of this study was to verify that stratum corneum could control strain distribution during facial expressions, which in turn leads to wrinkle formation. METHODS: In experiments in vivo, volunteers were instructed to smile under 10% or 80% relative humidity (dry or humid conditions, respectively). Skin movement around their eye corners during smiling was captured by a high-speed video camera. Particle-tracking velocimetry was applied to video recordings to analyse skin strain distribution. Also, wrinkle volumes before or after smiling were measured using replicas. RESULTS: With smiling under dry conditions, high strain was localized to form crease-shaped wrinkles whereas, under humid conditions, localized strain was dispersed. Furthermore, increased wrinkle volume after smiling was promoted under dry conditions. CONCLUSION: Because exposure to dry or humid conditions in the short term could affect only stratum corneum mechanics, the present results indicated that stratum corneum could be considered to be responsible for localized strain during facial expressions. This strain is followed by residual wrinkle formation. Accumulation of residual wrinkles will produce permanent wrinkles in the long term. Improving the mechanics of stratum corneum might be an effective approach in wrinkle formation prevention.

A new quantitative evaluation method for age-related changes of individual pigmented spots in facial skin.

BACKGROUND: Facial skin pigmentation is one of the most prominent visible features of skin aging and often affects perception of health and beauty. To date, facial pigmentation has been evaluated using various image analysis methods developed for the cosmetic and esthetic fields. However, existing methods cannot provide precise information on pigmented spots, such as variations in size, color shade, and distribution pattern. The purpose of this study is the development of image evaluation methods to analyze individual pigmented spots and acquire detailed information on their age-related changes. METHODS: To characterize the individual pigmented spots within a cheek image, we established a simple object-counting algorithm. First, we captured cheek images using an original imaging system equipped with an illumination unit and a high-resolution digital camera. The acquired images were converted into melanin concentration images using compensation formulae. Next, the melanin images were converted into binary images. The binary images were then subjected to noise reduction. Finally, we calculated parameters such as the melanin concentration, quantity, and size of individual pigmented spots using a connected-components labeling algorithm, which assigns a unique label to each separate group of connected pixels. RESULTS: The cheek image analysis was evaluated on 643 female Japanese subjects. We confirmed that the proposed method was sufficiently sensitive to measure the melanin concentration, and the numbers and sizes of individual pigmented spots through manual evaluation of the cheek images. The image analysis results for the 643 Japanese women indicated clear relationships between age and the changes in the pigmented spots. CONCLUSION: We developed a new quantitative evaluation method for individual pigmented spots in facial skin. This method facilitates the analysis of the characteristics of various pigmented facial spots and is directly applicable to the fields of dermatology, pharmacology, and esthetic cosmetology.

Postoperative infectious complications after pancreatic resection.

BACKGROUND: Although mortality associated with pancreatic surgery has decreased dramatically, high morbidity rates are still of major concern. This study aimed to identify the prevalence of, and risk factors for, infectious complications after pancreatic surgery. METHODS: The Japanese Society of Pancreatic Surgery conducted a multi-institutional analysis of complications in patients who underwent pancreaticoduodenectomy (PD) or distal pancreatectomy (DP) between January 2010 and December 2012. Risk factors that were significantly associated with infectious complications in univariable models were included in a multivariable logistic regression model, and a nomogram was created to predict the risk of infectious complications after pancreatectomy. RESULTS: Infectious complications occurred in 1459 (35.2 per cent) of 4147 patients in the PD group and 426 (25.2 per cent) of 1692 patients in the DP group (P < 0.001). Nine risk factors for infectious complications after PD were identified: male sex, age 70 years or more, body mass index at least 25 kg/m(2), other previous malignancy, liver disease, bile contamination, duration of surgery 7 h or longer, intraoperative blood transfusion and soft pancreas. Five risk factors for infectious complications after DP were identified: chronic steroid use, smoking, duration of surgery 5 h or more, intraoperative blood transfusion and non-laparoscopic surgery. Occurrence of a postoperative infectious complication was significantly associated with mortality and reoperation after PD (odds ratio (OR) 4.33, 95 per cent c.i. 2.01 to 9.92 and OR 3.26, 1.86 to 5.82, respectively) and DP (OR 6.32, 1.99 to 22.55; OR 3.74, 1.61 to 9.04). CONCLUSION: Prolonged operating time, intraoperative blood transfusion, bile contamination (PD) and non-laparoscopic surgery (DP) are risk factors for postoperative infectious complications that could be targeted to improve outcome after pancreatectomy.

Three-dimensional morphological characterization of the skin surface micro-topography using a skin replica and changes with age.

BACKGROUND/PURPOSE: Skin surface micro-topography (SSMT), consisting of pores, ridges and furrows, reflects the skin condition and is an important factor determining the aesthetics of the skin. Most previous studies evaluating SSMT have employed two-dimensional image analysis of magnified pictures captured by a video microscope. To improve the accuracy of SSMT analysis, we established a three-dimensional (3D) analysis method for SSMT and developed various parameters including the skin ridge number, and applied the method to study the age-dependent change in skin. METHODS: Confocal laser scanning microscopy was used for 3D measurement of the surface morphology of silicon replicas taken from the cheek. We then used these data to calculate the parameters that reflect the nature of SSTM including the skin ridge number using originally developed software. Employing a superscription technique, we investigated the variation in SSMT with age for replicas taken from the cheeks of 103 Japanese females (5-85 years old). RESULTS: The skin surface area and roughness, the area of pores, the area, length, depth and width of skin furrows and the number of skin ridges were examined. The surface roughness, the area of pores and the depth of skin furrows increased with age. The area and length of skin furrows and the number of skin ridges decreased with age. CONCLUSION: The method proposed to analyse SSMT three dimensionally is an effective tool with which to characterize the condition of the skin.

NY-ESO-1 antibody as a novel tumour marker of gastric cancer.

BACKGROUND: NY-ESO-1 antibodies are specifically observed in patients with NY-ESO-1-expressing tumours. We analysed whether the NY-ESO-1 humoral immune response is a useful tumour marker of gastric cancer. METHODS: Sera from 363 gastric cancer patients were screened by enzyme-linked immunosorbent assay (ELISA) to detect NY-ESO-1 antibodies. Serial serum samples were obtained from 25 NY-ESO-1 antibody-positive patients, including 16 patients with curative resection and 9 patients who received chemotherapy alone. RESULTS: NY-ESO-1 antibodies were detected in 3.4% of stage I, 4.4% of stage II, 25.3% of stage III, and 20.0% of stage IV patients. The frequency of antibody positivity increased with disease progression. When the NY-ESO-1 antibody was used in combination with carcinoembryonic antigen and CA19-9 to detect gastric cancer, information gains of 11.2% in stages III and IV, and 5.8% in all patients were observed. The NY-ESO-1 immune response levels of the patients without recurrence fell below the cutoff level after surgery. Two of the patients with recurrence displayed incomplete decreases. The nine patients who received chemotherapy alone continued to display NY-ESO-1 immune responses. CONCLUSION: When combined with conventional tumour markers, the NY-ESO-1 humoral immune response could be a useful tumour marker for detecting advanced gastric cancer and inferring the post-treatment tumour load in seropositive patients.

Improvement in skin color achieved by smoking cessation.

It has been well known that habitual smoking accelerates premature skin ageing recognized as 'smoker's face'. However, the effect of smoking cessation on the appearance of skin has not been elucidated. The aim of this study was to evaluate objectively the effect of smoking cessation on the skin's appearance. The stratum corneum carbonyl protein level and skin colour of the cheek and the hand were measured. The change before and during the smoking cessation treatment (0, 2, 4, 8 and 12 weeks), and the success or failure in smoking cessation, was compared and examined. Eighty-four cases who had smoking cessation treatment were examined. The level of the stratum corneum carbonyl protein did not show any difference comparing before and after treatment for the smoking cessation success group and the failure group. The lightness of skin colour showed an upward tendency 4-12 weeks after starting the treatment in the success group and increased significantly compared with the failure group. The redness showed a significant decrease in comparison with before the treatment, and it also showed a significant decrease compared with the failure group. The yellowness did not show any clear tendency. Also, the haemoglobin showed a decreased tendency. Furthermore, multivariate statistical analysis showed a possibility that the lightness and haemoglobin could be changed by smoking cessation treatment. In conclusion, our study showed that an upward tendency of skin lightness was seen to correspond with a haemoglobin decrease accompanied by smoking cessation. If we can easily measure skin improvement as an effect of smoking cessation, it is thought to be a useful aid for smoking cessation support.

Development and characterization of chloroplast microsatellite markers for Cryptomeria japonica D. Don.

We developed 17 chloroplast microsatellite markers, which consisted of seven mononucleotide microsatellites with a minimum repeat number of 10 and 10 dinucleotide microsatellites with a minimum repeat number of six, from the complete chloroplast genomic sequence of Cryptomeria japonica. A survey of 45 C. japonica individuals showed the number of alleles ranging from two to 11 alleles and a diversity index ranging from 0.085 to 0.895. Consequently, the 45 C. japonica individuals were divided into 39 haplotypes. These markers will be useful genetic markers in the gene flow analysis and population genetics of C. japonica.

Protein carbonyls damage the water-holding capacity of the stratum corneum.

BACKGROUND: Acrolein is a degradation product of lipid peroxide as well as a well-known environmental pollutant. As a hallmark of oxidatively damaged protein, protein carbonyl, including acrolein-protein adduct, has been observed in the skin. However, the influence of protein carbonylation on the stratum corneum (SC) has not yet been clarified. OBJECTIVES: We explored the influence of oxidative protein modification, focusing on the major function of the SC, the water-holding capacity, by introducing experimental protein carbonylation. METHODS: The level of carbonyls in the SC was evaluated by reaction with a labeled hydrazide. The water-holding capacities of the SC or keratin gels were evaluated by measurement of the surface conductance. The bound water (nonfreezing water) content in the SC was measured by the heat of fusion of frozen SC. RESULTS: Acrolein caused protein carbonylation, decreased the water-holding capacity and the bound water of the porcine SC in vitro. The water-holding capacity of the keratin gels prepared from human SC was also decreased by acrolein in vitro. Water content in the human SC in vivo was decreased by sodium hypochlorite and accompanied by the increase in carbonyls. CONCLUSION: Exposure of SC to the oxidative environment damages the water-holding capacity of the SC through the modification of protein-water interaction.

Increased carbonyl protein levels in the stratum corneum of the face during winter.

The stratum corneum (SC) is the interface between the body and the environment, and is continuously exposed to oxidative stress that results in carbonyl modification of proteins. We previously developed a simple and non-invasive method to assess the stratum corneum carbonyl protein (SCCP) levels. In this study, we used this method to examine the seasonal changes in the SCCP levels and the relationship between the SCCP level and the physiological condition of the SC. SC was collected from the face of healthy Japanese volunteers by adhesive tape stripping and its carbonyl groups were determined by reaction with fluorescein-5-thiosemicarbazide. The average fluorescence intensity of the SC was calculated as the SCCP level. The SCCP level in the cheek was higher in winter than summer. The SCCP level was negatively correlated with the water content in the SC measured by the conductance and capacitance, and also negatively correlated with the extensibility of the skin measured by a Cutometer, suggesting that the mechanical properties of the skin can be affected by oxidative modification of the SC. These data suggest the involvement of oxidative modification of SC proteins in the generation of rough skin during winter.

Change in optical properties of stratum corneum induced by protein carbonylation in vitro.

The skin is the frontier against the external environment and continuously exposed to the environmental oxidative stress such as ultraviolet (UV) irradiation. Protein carbonyls are the major oxidative products of protein and may be introduced by reaction with aldehydes derived from lipid peroxide. Acrolein is one of the most reactive aldehydes generated during degradation of lipid peroxides and protein-acrolein adducts have been found in the oxidatively damaged lesion including UV-damaged skin. Recent studies revealed that protein carbonyls are also detected in thin outermost layer of the skin, the stratum corneum (SC). However, the effect of protein carbonylation on the function of SC was still unclear. In this study, we treated the SC sheets of reconstructed human epidermis and porcine epidermis with acrolein in the experimental conditions to explore the influence of protein carbonylation on the SC. Human and porcine SC sheets treated with acrolein showed less transmission at visible light than untreated SC sheets. Attenuated total reflection-infrared spectroscopy with curve fitting analysis of amide I region showed that acrolein induced alterations in protein secondary structure of the porcine SC sheets, which were accompanied by diminished fibrous keratin structure observed by transmission electron microscopy. These results show the possibility that carbonylation of the SC caused by environmental factors is one of factors altering the fibrous structure of keratin and decreasing the light transmission of SC, which changes the quality of the skin appearance.

Long-term and short-term evaluation of esophageal reconstruction using the colon or the jejunum in esophageal cancer patients after gastrectomy.

For esophageal cancer patients, the gastric tube is the first choice as an esophageal substitute, with the colon or the jejunum being used when the stomach cannot be used. We retrospectively compared these two methods from the viewpoint of peri-operative complications and long-term bodyweight alteration. From 1998 to 2005 53 patients who had undergone subtotal esophagectomy due to thoracic esophageal cancers were given reconstruction with the colon (28 cases) or the jejunum (25 cases). Both intestines were reconstructed via the subcutaneous route and were anastomosed to the internal mammalian artery and vein for a supercharged blood supply. There was no difference in operating time and blood loss. Compared with the colon reconstruction group, the hospital stay of the jejunum reconstruction group was significantly shorter (65 days vs 45 days, P = 0.0120) and the incidence of anastomotic leakage tended to be less (13 cases, 46%vs 6 cases, 24%, P = 0.1507), while other operative morbidity did not differ between the two groups. Bodyweight loss, which is a serious postoperative sequela after esophagectomy, was less in the jejunum group than in the colon group, showing a significant difference at 12 months after surgery. Our retrospective study revealed the jejunum to be superior to the colon for the reconstruction after esophagectomy along with gastrectomy, with respect to anastomotic leakage and bodyweight loss. The next step will be to conduct a prospective large cohort study.

Evaluation of clinical significance of 18F-fluorodeoxyglucose positron emission tomography in superficial squamous cell carcinomas of the thoracic esophagus.

(18)F-fluorodeoxyglucose (FDG) positron emission tomography (PET) is used for pre-treatment staging and evaluation of response to pre-operative therapy in advanced thoracic esophageal cancers. To evaluate the clinical significance of PET diagnosis of superficial thoracic esophageal cancers, FDG-PET was conducted preoperatively in 41 patients with such cancers without pre-operative therapy. We compared the PET diagnosis with clinicopathological findings with respect to both the primary tumor and lymph node (LN) metastasis. Of the 41 superficial thoracic esophageal cancers, 21 (51.2%) were PET positive for primary tumors. Although tumor length and histological type did not correlate with FDG uptake by primary tumors, non-flat (elevated or depressed) tumors showed significantly stronger FDG uptake than flat ones. Of 28 tumors infiltrating the deep submucosal layer, 19 (67.9%) were PET positive, while only two (15.4%) of 13 tumors infiltrating only the mucosa or shallow submucosal layer were PET positive. Manova identified FDG uptake as the only independent risk factor for deep submucosal invasion (odds ratio, 7.407; P = 0.0279). In 13 patients with pathological LN metastasis, although no LN metastasis was detected by FDG-PET, FDG uptake by the primary tumors was the only risk factor for LN metastasis (P = 0.0318). PET-negative tumors tended to reflect longer disease-free survival than PET-positive tumors, although this was not significant. FDG-PET is useful for detecting tumors infiltrating the middle or deep submucosal layer (sm2/sm3), and for predicting LN metastasis in patients with superficial thoracic esophageal cancers. FDG-PET is helpful for decision-making regarding treatment of such patients.

Fourier transform microwave spectroscopy of the isocyanomethyl radical, CH(2)NC.

The pure rotational spectrum of the isocyanomethyl radical, CH(2)NC, was measured for the first time by using a Fourier transform microwave spectrometer. The molecule was produced by a discharge of isocyanomethane, CH(3)NC, diluted in Ar or Ne. The spectral lines due to the N=1-0 and 2-1 transitions were recorded near 22 and 44 GHz, respectively. The observed spectrum showed a complicated fine and hyperfine structure because of the same order of interaction energies. Among the 39 spectral lines detected and assigned, the transitions with K(a)=1 show no hyperfine splitting due to the hydrogen nuclei, suggesting planarity for the molecule. Molecular constants such as rotational and spin-rotational parameters including centrifugal effects and hyperfine coupling constants due to both the nitrogen and the hydrogen nuclei were accurately determined. The structure and the astronomical implications of the molecule are discussed.

Submillimeter-wave spectroscopy of DCO+ in the excited vibrational states: does the Stark effect cause anomalies in the (02(2)0) state?

The lowest two rotational transitions of (02(2)0) were not detected in previous investigations. This nonobservation was ascribed to the Stark broadening caused by the electric field in a hollow cathode discharge and an extended negative glow discharge. However, rotational lines of symmetric-top ions such as CH(3)CNH(+) and SD(3)(+) were observed in extended negative glow discharges with no such Stark effect. Also, no anomalies were observed for similar lines for HCN and HNC produced in an extended negative glow discharge. In the present investigation, we extended the measurements of DCO(+) up to 800 GHz. The DCO(+) ions were produced in an extended negative glow discharge in a gas mixture of D(2) and CO (a couple of millitorr each) in Ar buffer ( approximately 12 mTorr). The measurements were made mostly at liquid nitrogen temperature. Our observations confirmed that the lowest rotational lines in (02(2)0) within our frequency coverage, J=4-3, were too weak to be detected. However, a most notable result obtained in the present investigation is that the J=5-4 and J=6-5 lines of (02(2)0) and the J=5-4 line of (04(2)0) have been detected in induced emission. This observation implies that the previous nonobservation of low-J lines in (02(2)0) may not be due to the Stark effect. The l-type splitting in (03(3)0) has been observed for the J=9-8 transition and higher. However, the splittings for the J=7-6 and J=8-7 lines that are expected to be large enough have not been resolved. The reason for this "narrowing" has been unexplained at the present stage. The population inversion suggests that, initially, DCO(+) is formed predominantly in stretching vibrational states, and, subsequently, the energy transfer to bending vibrational states takes place through collisional relaxation processes.

Diagnostic clinical application of two-color fluorescence in situ hybridization that detects chromosome 1 and 17 alterations to direct touch smear and liquid-based thin-layer cytologic preparations of endometrial cancers.

We performed two-color fluorescence in situ hybridization (FISH) on direct touch smears and liquid-based thin-layer (ThinPrep) cytological preparations of endometrial tumors to detect alterations of chromosome 1 and 17 that present with high incidence in endometrial cancers. The DNA probes used for two-color FISH analysis were a combination of the probes designed for 17cen (cCI 17-321) and 17p13.3 (D17S34), and a combination of the probes designed for 1q12 (D1Z1) and 1p36 (cCI1-5335). Numerical or structural alterations of chromosome 1 and/or 17 were detected in 95% (19 of 20 cases) of the direct touch smears obtained from endometrial cancer, while these alterations were also detected in 93% (12 of 13 cases) of samples obtained from grade 1 endometrioid adenocarcinoma cases, including three cases that could not be diagnosed as positive by conventional Papanicolaou cytopathologic staining. Using ThinPrep cytopathologic preparations, numerical or structural abnormalities were found in 26 (90%) and five (100%) cases, respectively, of samples obtained transcervically from 29 endometrial cancer and five atypical endometrial hyperplasia cases. Therefore, two-color FISH may be a useful diagnostic method for endometrial adenocarcinoma and premalignant lesions that demonstrate only slight cellular atypia in conventional cytopathologic preparations.

A population-based study of immunohistochemical detection of p53 alteration in bladder cancer.

The molecular pathology of bladder cancer has been the subject of considerable interest and mutation of the p53 gene, which has been associated with more invasive bladder cancer, has been widely studied. Further, there is evidence that p53 inactivation (either mutation or protein dysregulation), independent of stage, may be predictive of bladder cancer progression. In an effort to avoid possible biases associated with selection of more advanced cases, we examined p53 inactivation in a population-based study of bladder cancer in New Hampshire, using both mutation and immunohistochemical methods. We found the overall prevalence of mutation to be approximately 10%, while immunohistochemical analysis suggests that approximately 66% of the tumours have dysregulated p53 at the protein level. There was a significant association of mutation with persistent p53 staining, but there remained a marked number of tumours discordant for mutation and aberrant p53 immunohistochemistry. Based upon immunohistochemical staining alone, intensity rather than extent of p53 staining was more strongly related to tumour invasiveness. Additionally, all tumours with a mutation in exon 8 stained intensely. Taken together, this suggests that intense staining represents a distinct phenotype of dysfunctional protein. Our data indicate that population-based approaches to somatic alteration of p53 in bladder cancer are crucial to understanding the relationship of p53 changes to aetiology and the outcome of this disease, and further suggest that the pattern of immunohistochemical staining may represent distinct, discernible phenotypes. British Journal of Cancer (2004) 90, 1572-1576. doi:10.1038/sj.bjc.6601748 www.bjcancer.com Published online 6 April 2004

Stratum corneum lipid profile and maturation pattern of corneocytes in the outermost layer of fresh scars: the presence of immature corneocytes plays a much more important role in the barrier dysfunction than do changes in intercellular lipids.

BACKGROUND: The functional characteristics of the stratum corneum (SC) of fresh scars as well as keloids and hypertrophic scars are characterized by elevated transepidermal water loss (TEWL) and increased SC hydration. OBJECTIVES: To study the composition of the intercellular lipids and maturation properties of the cornified envelope (CE) of the SC, as these are the most important components for the SC barrier function in fresh scars. METHODS: SC lipids were extracted from the donor site for split-thickness skin grafting soon after re-epithelialization using a cup method, and were analysed with high-performance thin-layer chromatography. CEs, which were prepared from superficial layers of the SC, were double stained with Nile red and anti-involucrin. RESULTS: We found a significant decrease in the proportion of ceramide (CER) in the SC lipids of fresh scars. We also observed changes in the SC CER profile that consisted of an increase in CER 4 and CER 7 and a decrease in CER 3, without any significant change in the proportion of CER 1. These changes were insufficient to explain the remarkably high TEWL recorded in the early stage of fresh scars. In contrast, with double staining of CE with Nile red and anti-involucrin, we detected the presence of numerous immature and less hydrophobic corneocytes in the outermost layer of the SC of fresh scars. Scanning electron microscopy of such corneocytes revealed numerous fine wrinkles on their enlarged surface area. Most of all, we found a closely similar, time-dependent, exponential decrease in the ratio of immature corneocytes with a poorly hydrophobic CE and in the recorded TEWL values in fresh scars. There was a highly significant positive correlation between the proportion of immature corneocytes in the outermost layer of the SC and TEWL values. CONCLUSIONS: These results suggest that the SC barrier dysfunction of the fresh scars is attributable to the presence of immature corneocytes with a less hydrophobic CE, rather than to the changes in SC lipid composition.