[A Case of Late Recurrence of Gastric Cancer Over Ten Years Post Gastrectomy].

A 72-year-old woman underwent a low anterior resection of the rectum and a total hysterectomy with a bilateral salpingo- oophorectomy simultaneously for rectal and ovarian cancer, respectively. The pathological diagnosis was a moderately differentiated adenocarcinoma of the rectum with some poorly differentiated components signet-ring cell components. A mucinous adenocarcinoma, with similar characteristics as that in the rectum, was found in the ovary. Intraoperative findings revealed no direct invasion between the rectum and ovaries, with no peritoneal dissemination. She was, therefore, diagnosed with synchronous double cancer. The rectal cancer was pT3N0M0, Stage Ⅱ and the ovarian cancer pStage Ⅰ. Adjuvant chemotherapy with capecitabine was performed for high-risk Stage Ⅱ rectal cancer. At 3.5 years after surgery, her CA19-9 level was high and pleural dissemination and para-aortic lymph node metastasis were confirmed on thoracoabdominal CT. Twelve years after the gastrectomy for gastric cancer, a comparison of the pathological specimens of her stomach at that time with the current pathological specimens revealed that the rectal and ovarian tumors were metastases of gastric cancer and that the current recurrence was a late recurrence of this disease. Late recurrence after gastrectomy, especially 10 years or more after surgery, is extremely rare.

Differences in fish herbivory among tropical and temperate seaweeds and annual patterns in kelp consumption influence the tropicalisation of temperate reefs.

Climate change is leading to novel species interactions and profoundly altering ecosystems. In marine systems, tropical and subtropical species are increasing in higher latitudes. This has been linked to the deforestation of temperate coastlines, as direct effects of ocean warming combine with increased herbivory from tropical and sub-tropical fishes and lead to the decline of canopy-forming kelp. Here, we tested the hypothesis that this deforestation may be facilitated by greater palatability of temperate kelp and other canopy seaweeds compared to tropical taxa. We used multiple-choice filmed feeding field experiments and chemical analyses to measure the palatability of temperate and tropical seaweeds from Tosa Bay (southeastern Japan) and we used single-species feeding assays to measure changes in consumption of the kelp Ecklonia cava throughout the year. We found no evidence that temperate seaweeds are more palatable to herbivorous fish. In the multiple-choice assays, consumption was concentrated on both tropical and temperate Sargassum species, which are ephemeral and peak in abundance in the spring/early summer. Consumption of the kelp Ecklonia cava peaked during the autumn, when Sargassum species are absent. The highest levels of kelp herbivory coincide with the reproductive season for E. cava and may contribute to the long-term decline of these kelp forests in southern Japan.

Right atrial obstruction due to cardiac extension of hepatocellular carcinoma.

Hepatocellular carcinoma is fatal and has a marked propensity for vascular invasion. However, tumor thrombi rarely occur in the right atrium. A 72-year-old man was admitted with dyspnea and disturbed consciousness. Abdominal computed tomography and echocardiography showed a huge tumor thrombus in the inferior vena cava and the right atrium. The tumor thrombus was surgically removed to treat the hemodynamic compromise. The patient underwent transcatheter arterial chemoembolization postoperatively and survived for 6 months.

Occlusion of left coronary ostium with a rudimentary aortic cusp.

A 74-year-old woman with exertional angina was diagnosed with occlusion of the left coronary ostium associated with a rudimentary aortic valve cusp. A transesophageal echocardiogram, a multi-detector computed tomographic scan, and a coronary angiographic scan revealed the rudimentary aortic cusp covering the small left coronary aortic sinus leading to occlusion of the ostium of the left coronary artery, despite the intact coronary arteries. After excision of the rudimentary left coronary cusp, the left coronary ostium appeared intact. An aortic valve replacement with annular enlargement using a bioprosthetic valve was performed. The patient uneventfully recovered without angina.

Transformation of poplar (Populus alba) plastids and expression of foreign proteins in tree chloroplasts.

Plastid transformation offers several unique advantages compared with nuclear genome transformation, such as high level of transgene expression within plastids, expressing multiple transgenes as operons, lack of position effect due to site-specific transgene integration, and reducing risks of gene flow via pollen due to maternal inheritance of the plastid genome. Plastid transformation has been applied to several herbal species, but as yet there are no applications to tree species. We report here the first successful plastid transformation in a tree species, Populus alba. A vector for plastid transformation of poplar (Populus alba) was constructed, which carried the spectinomycin resistance gene and the green fluorescence protein gene as marker genes. In the regenerated shoots, the site-specific integration of foreign genes and the establishment of a high homoplastomic state were confirmed. Immunoblot analysis and histological observations corroborated the accumulation of green fluorescence protein in chloroplasts. The establishment of a plastid transformation system in poplar provides a novel tool for tree biotechnology.

Efficient and stable transformation of Lactuca sativa L. cv. Cisco (lettuce) plastids.

Transgenic plastids offer unique advantages in plant biotechnology, including high-level foreign protein expression. However, broad application of plastid genome engineering in biotechnology has been largely hampered by the lack of plastid transformation systems for major crops. Here we describe the development of a plastid transformation system for lettuce, Lactuca sativa L. cv. Cisco. The transforming DNA carries a spectinomycin-resistance gene (aadA) under the control of lettuce chloroplast regulatory expression elements, flanked by two adjacent lettuce plastid genome sequences allowing its targeted insertion between the rbcL and accD genes. On average, we obtained 1 transplastomic lettuce plant per bombardment. We show that lettuce leaf chloroplasts can express transgene-encoded GFP to approximately 36% of the total soluble protein. All transplastomic T0 plants were fertile and the T1 progeny uniformly showed stability of the transgene in the chloroplast genome. This system will open up new possibilities for the efficient production of edible vaccines, pharmaceuticals, and antibodies in plants.

Intraatrial rerouting by atrial flaps for partial anomalous pulmonary venous return.

We report a new surgical correction technique using an autologous atrial septal flap and anterolateral right atrial wall in a 3-year-old girl with partial anomalous pulmonary venous return and lower margin atrial septal defect. The patient recovered smoothly and is doing well 3 years after the operation.

Sudden death under successful medical management of sick sinus syndrome after cardiac pacing discontinuation.

Bacterial infection is a serious complication of permanent pacemaker implantation. A 52-year-old woman with sick sinus syndrome and vasospastic angina developed pacemaker infection 4 years after implantation, with methicillin-resistant Staphylococcus aureus detected in arterial blood cultures. We treated the septicemia with antibiotics and removed the infected pacemaker. We treated sick sinus syndrome with intravenous nitroglycerin followed by oral maintenance isosorbide mononitrate. After cardiac pacing was discontinued following removal of the infected permanent pacemaker, the patient remained well, until her sudden death 3.5 years later. Although the precise cause of death was not clear, we suspected sick sinus syndrome or vasospastic angina, and now consider the outcome may have been more favorable if we had reimplanted a permanent pacemaker before she died.