Doxorubicin-Resistant TNBC Cells Exhibit Rapid Growth with Cancer Stem Cell-like Properties and EMT Phenotype, Which Can Be Transferred to Parental Cells through Autocrine Signaling.

Emerging evidence suggests that breast cancer stem cells (BCSCs), and epithelial-mesenchymal transition (EMT) may be involved in resistance to doxorubicin. However, it is unlear whether the doxorubicin-induced EMT and expansion of BCSCs is related to cancer dormancy, or outgrowing cancer cells with maintaining resistance to doxorubicin, or whether the phenotypes can be transferred to other doxorubicin-sensitive cells. Here, we characterized the phenotype of doxorubicin-resistant TNBC cells while monitoring the EMT process and expansion of CSCs during the establishment of doxorubicin-resistant MDA-MB-231 human breast cancer cells (DRM cells). In addition, we assessed the potential signaling associated with the EMT process and expansion of CSCs in doxorubicin-resistance of DRM cells. DRM cells exhibited morphological changes from spindle-shaped MDA-MB-231 cells into round-shaped giant cells. They exhibited highly proliferative, EMT, adhesive, and invasive phenotypes. Molecularly, they showed up-regulation of Cyclin D1, mesenchymal markers (ß-catenin, and N-cadherin), MMP-2, MMP-9, ICAM-1 and down-regulation of E-cadherin. As the molecular mechanisms responsible for the resistance to doxorubicin, up-regulation of EGFR and its downstream signaling, were suggested. AKT and ERK1/2 expression were also increased in DRM cells with the advancement of resistance to doxorubicin. Furthermore, doxorubicin resistance of DRM cells can be transferred by autocrine signaling. In conclusion, DRM cells harbored EMT features with CSC properties possessing increased proliferation, invasion, migration, and adhesion ability. The doxorubicin resistance, and doxorubicin-induced EMT and CSC properties of DRM cells, can be transferred to parental cells through autocrine signaling. Lastly, this feature of DRM cells might be associated with the up-regulation of EGFR.

Autonomous Magnetic Microrobots by Navigating Gates for Multiple Biomolecules Delivery.

The precise delivery of biofunctionalized matters is of great interest from the fundamental and applied viewpoints. In spite of significant progress achieved during the last decade, a parallel and automated isolation and manipulation of rare analyte, and their simultaneous on-chip separation and trapping, still remain challenging. Here, a universal micromagnet junction for self-navigating gates of microrobotic particles to deliver the biomolecules to specific sites using a remote magnetic field is described. In the proposed concept, the nonmagnetic gap between the lithographically defined donor and acceptor micromagnets creates a crucial energy barrier to restrict particle gating. It is shown that by carefully designing the geometry of the junctions, it becomes possible to deliver multiple protein-functionalized carriers in high resolution, as well as MCF-7 and THP-1 cells from the mixture, with high fidelity and trap them in individual apartments. Integration of such junctions with magnetophoretic circuitry elements could lead to novel platforms without retrieving for the synchronous digital manipulation of particles/biomolecules in microfluidic multiplex arrays for next-generation biochips.

Effects of deep breathing on internal oblique and multifidus muscle activity in three sitting postures.

[Purpose] This study was to investigate differences in the level of activity of the external oblique (EO), internal oblique (IO), and multifidus (MF) muscles with deep breathing in three sitting postures. [Subjects and Methods] Sixteen healthy women were recruited. The muscle activity (EO, IO, MF) of all subjects was measured in three sitting postures (slumped, thoracic upright, and lumbo-pelvic upright sitting postures) using surface electromyography. The activity of the same muscles was then remeasured in the three sitting postures during deep breathing. [Results] Deep breathing significantly increased activity in the EO, IO, and MF compared with normal breathing. Comparing postures, the activity of the MF and IO muscles was highest in the lumbo-pelvic upright sitting posture. [Conclusion] An lumbo-pelvic upright sitting posture with deep breathing could increase IO and MF muscle activity, thus improving lumbo-pelvic region stability.

Clinical Analysis of Stercoral Perforation without Mortality.

AIMS: This study was designed to review the clinical features of stercoral colonic perforation and to evaluate the appropriate intraoperative procedures and postoperative management to achieve the best surgical outcomes. METHODS: Between January 2009 and December 2015, 12 patients with stercoral perforation confirmed surgically and pathologically were included in this study, and their medical records were reviewed retrospectively. RESULTS: The enrolled patients included 2 men and 10 women; their mean age was 73.8 years. Abdomino-pelvic CT was an important diagnostic tool, which revealed fecalomas, extraluminal air and pericolic fat stranding in all patients. Hartmann's operation was performed in all patients, with a mean operation time of 239.3 min. Perforation site was in the left colon, mainly in the sigmoid colon. Intraoperative hypotension developed in 8 cases (66.7%). Postoperatively, all patients needed intensive care for 6.5 days and 6 patients needed the administration of inotropic agents for 3.0 days postoperatively. Disseminated intravascular coagulation developed in 10 cases (83.3%). There was no surgical mortality. CONCLUSION: Colorectal surgeons should be aware of the possibility of stercoral perforation, despite its rare incidence. Deep understanding of this potentially fatal disease by surgeons could reduce surgical mortality and improve postoperative outcomes.

Parental control and college students' depressive symptoms: A latent class analysis.

We examined how maternal and paternal parental control (helicopter parenting, behavioral control, and psychological control) among college students are related to their depressive symptoms. We collected data from college students who attended a private university in Upstate New York (n = 455) and analyzed it using three-step latent class analysis. Latent class analysis identified four parental control latent classes: weak parental control, strong psychological control, strong helicopter parenting, and strong parental control. College students in the weak parental control class reported lower depressive symptoms than those in strong psychological control and strong parental control classes. In addition, college students in the strong helicopter parenting class reported lower depressive symptoms than those in strong psychological control and strong parental control classes. College students' depressive symptoms were not significantly different between weak parental control and strong helicopter parenting classes. Future researchers are encouraged to continue to acknowledge the characteristics of different forms of parental control and their influence on college students' quality of life in the transition to adulthood, considering the unique approaches of both parents.

Can helicopter parenting be beneficial for parent-child relationships? A person-centered approach in the United States and South Korea.

Introduction: We aimed to uncover latent classes of maternal and paternal helicopter parenting among American and Korean college students and to examine whether latent classes of maternal and paternal helicopter parenting are associated with parent- child relationships. Methods: We conducted three-step latent class analyses using five helicopter parenting indicators for 433 mother-child and 401 father-child groups in the United States and 207 mother-child and 195 father-child groups in South Korea. Results: We identified the same three helicopter parenting latent classes (strong, weak, and managed) in mother-child and father-child groups in the United States and Korea. In addition, we found that American and Korean college students in strong and managed helicopter parenting latent classes reported better parent- child relationships than those in the weak class regardless of parents' gender. Discussion: Our findings indicate that helicopter parenting is multidimensional and can be similarly interpreted by college students in Western and Eastern societies. Further, our findings suggest that helicopter parenting could be helpful for college students to establish an intimate relationship with their parents.

The Effects of Abdominal Hollowing and Bracing Maneuvers on Trunk Muscle Activity and Pelvic Rotation Angle during Leg Pull Front Pilates Exercise.

Pilates methods use mats for trunk muscles stabilization exercises, and leg pull front (LPF) is one of the traditional Pilates mat exercises. Abdominal hollowing (AH) and Abdominal bracing (AB) maneuvers are recommended to stabilize the trunk muscles and prevent unwanted pelvic movement during motion. This study aimed to explore the effects of AH and AB on electromyography (EMG) activity of the trunk muscles and angle of pelvic rotation during LPF. A total of 20 healthy volunteers participated in the study. AH, AB, and without any condition (WC) were randomly performed during LPF exercise. Each was repeated three times for 5 s. The trunk muscle activities were measured using EMG and rotation of pelvis was measured using a Smart KEMA device. The activities of the transversus abdominis/obliquus internus abdominis (TrA/IO) and right obliquus externus abdominis (EO) muscles were highest in LPF-AH compared to the other conditions. Multifidus (MF) activity was significantly greater in LPF-AH and LPF-AB compared to that of without any condition. The pelvic rotation angle was significantly smaller in LPF-AB. Therefore, AH maneuver during LPF for trunk muscle stabilization exercises is suitable for selective activation of the TrA/IO, and AB maneuver during LPF is recommended for the prevention of unwanted pelvic rotation.

A multidimensional construct of helicopter parenting and college students' game and social media addictive behaviors: A cross-cultural study in South Korea and China.

Introduction: We explored latent classes of helicopter parenting among Korean and Chinese college students. In addition, we examined whether these latent classes of helicopter parenting are related to Korean and Chinese students' game and social media addictive behaviors. Methods: A three-step latent class analysis was conducted using 452 students from six universities in South Korea and 372 students from four universities in China. Results and discussion: We identified four distinct helicopter parenting latent classes among the parents of Korean and Chinese students: weak, strong, academic management, and academic and schedule management. We also found that Korean students in the strong class reported significantly higher levels of game and social media addictive behaviors than those in the other three classes, but this did not hold for Chinese students. This finding indicates that the association between helicopter parenting and college students' game and social media addictive behaviors can be differentiated within Asian cultural contexts.

Effect of Pelvic Floor Muscle Training Using Pressure Biofeedback on Pelvic Floor Muscle Contraction and Trunk Muscle Activity in Sitting in Healthy Women.

Pelvic floor muscle training (PFMT) has been recommended as the first choice as one of the effective methods for preventing and improving urinary incontinence (UI). We aimed to determine whether pressure biofeedback unit training (PBUT) improves short term and retention performance of pelvic floor muscle contraction. The muscle activities of the external oblique (EO), transversus/internal oblique (TrA/IO), multifidus (MF) and the bladder base displacement were measured in the verbal feedback group (n = 10) and PBU group (n = 10) three times (baseline, post-training, and at the 1-week follow-up). Surface electromyographic activity was recorded from the EO, TrA/IO, and MF muscles. The bladder base displacement was measured using ultrasound. The results were analyzed using two way mixed ANOVA. The bladder base displacement may have elevated more in the PBU group than in the verbal feedback group due to decreased TrA/IO activity. These findings indicate that PBUT is a better method than verbal feedback training.

A surgical hospitalist system in Korea: a preliminary study of the effects on hospital costs and postoperative outcomes.

PURPOSE: The aim of this study is to investigate the effect of the surgical hospitalist system on postoperative outcomes and hospital costs for surgical patients. METHODS: We reviewed the medical records of 522 patients who were admitted to the divisions of colorectal and gastrointestinal surgery for operation from September to December 2017 at Severance Hospital, Yonsei University College of Medicine in Seoul, Korea. All patients were divided into 2 groups; one that was managed by surgical hospitalists group (HG) and another that was managed by non-hospitalist residents group (NHG) after elective surgery. Postoperative outcomes and hospital costs were analyzed for each group. RESULTS: Two hundred ninety-eight patients were managed by HG and 189 patients were managed by NHG after surgery. The length of hospital stay in the first group was shorter (9.6 ± 5.8 days vs. 12.2 ± 7.9 days, P < 0.001), the incidence of complications was lower (44.6% vs. 55.6%, P = 0.019), and the readmission rate was lower (3.0% vs. 6.9%, P = 0.046) in the HG than in the NHG. The difference in total hospital costs was not significant between the HG and the NHG (₩8,381,304 vs. ₩9,242,493, P = 0.559), but surgery-independent hospital costs were lower in the HG than in the NHG (₩3,020,873 vs. ₩3,923,308, P = 0.001). CONCLUSION: The surgical hospitalist system reduced the length of hospital stay, the incidence of postoperative complications, and the readmission rates of surgical patients. This led to the effect of a reduction in total hospital costs.

Unpartnered Mothers' Work-Family Conflict and Parenting Stress: The Moderating Effects of Nonstandard Work Schedules.

Using the Fragile Families and Child Wellbeing Study dataset, we examined the moderating effects of nonstandard work schedules on the association between work-family conflict and parenting stress among unpartnered mothers one year after childbirth. A multiple-group analysis was conducted to examine the interaction between a latent continuous variable (work-family conflict) and observed categorical variables (four types of work schedules: daytime weekday, daytime weekend, nighttime weekday, and nighttime weekend). Results showed that unpartnered mothers' work-family conflict was positively associated with their parenting stress, regardless of their work schedules. In addition, unpartnered mothers' nonstandard work schedules moderated the association between work-family conflict and parenting stress. Contrary to our expectations, however, the negative effects of work-family conflict on parenting stress were alleviated in unpartnered mothers who worked nighttime compared to those who worked daytime weekend. This result indicates that working nights can be a strategy by which unpartnered mothers can balance work and family life. Specifically, using informal caregiving support, unpartnered mothers can have a respite from parenting by working nonstandard hours. Implications are discussed in terms of the importance of researchers' and policymakers' attention regarding unpartnered mothers' work and parenting issues.

Five-year survival rate among older adults participating in the national geriatric screening program: A South Korean population-based cohort study.

INTRODUCTION: This study aimed to assess the health benefits of a geriatric screening program comprising of physical function tests, screening questionnaires for depression and cognitive impairment, and bone mineral density measurements for women as a part of the National Screening Program for Transitional Ages (NSPTA). We compared the all-cause mortality between subjects who did and did not participate in the screening program. METHODS: This was a nationwide longitudinal study with a 5-year follow-up based on a 10% sample of the National Health Insurance beneficiaries aged 60 years and older. Mortality records were obtained from the qualification dataset in the elderly cohort database of 2005-2013 provided by the National Health Insurance Service. A Cox proportional hazards model was used to analyze the mortality risk. We sampled 11,986 subjects each in the screened (intervention) and non-screened (control) groups after exact matching using propensity score. RESULTS: After adjusting for demographic and socioeconomic characteristics (age, sex, household income, smoking, alcohol drinking, physical activity, body mass index, and the Charlson Comorbidity Index), all-cause mortality rates were found to be significantly lower (a) in the intervention group compared to the control group (hazard ratio = 0.73; 95% confidence interval: 0.65, 0.82) and (b) among women compared to men (hazard ratio = 0.50; 95% confidence interval: 0.44, 0.56). Lower hazard ratios were also observed among those with a higher body mass index, fewer comorbidities, and higher income. CONCLUSION: A nationwide geriatric screening program might be helpful in reducing the incidence of premature deaths among older people.

Brain metastasis from colorectal cancer: a single center experience.

PURPOSE: The detection rate of brain metastasis (BM) from colorectal cancer (CRC) is increasing. This study was designed to analyze the clinical features of BM and prognosis according to the therapeutic modalities. METHODS: A total of 19 cases were collected in this study between November 2008 and December 2015. We reviewed the patients' demographic data and the clinical features of BM retrospectively and investigated their prognostic significance. RESULTS: Nineteen patients included 8 male and 11 female patients. The median age at diagnosis of BM was 62.4 years (range, 32-83 years). The median interval between diagnosis of CRC and BM was 39 months (range, 0-98 months). Eighteen patients (94.7%) had extracranial metastasis at the diagnosis of BM. Lung was the most common site of extracranial metastasis in 14 patients (73.7%). Synchronous BMs were found at the diagnosis of primary CRC in 2 patients (10.5%). The location of primary CRC was the colon in 6 patients (31.6%) and the rectum in 13 patients (68.4%). At the diagnosis of BM, 10 patients (52.6%) had a solitary BM. The common neurologic symptoms were headache in 8 cases (42.1%) and ataxia in 6 cases (31.6%). The median survival after the diagnosis of BM was 3 months (range, 1-10 months). The patients who underwent surgery plus stereotactic radiosurgery (SRS) had an improved survival (range, 3-10 months) than the other patients (range, 1-6 months) (P = 0.016). CONCLUSION: In patients with BM from CRC, surgical resection plus SRS might improve survival.

Clinical Significance of Preoperative Virtual Colonoscopy for Evaluation of the Proximal Colon in Patient With Obstructive Colorectal Cancer.

PURPOSE: Virtual colonoscopy is the most recently developed tool for detecting colorectal cancers and polyps, but its effectiveness is limited. In our study, we compared the result of preoperative virtual colonoscopy to result of preoperative and postoperative colonoscopy. We evaluated also the accuracy of preoperative virtual colonoscopy in patients who had obstructive colorectal cancer that did not allow passage of a colonoscope. METHODS: A total of 164 patients who had undergone preoperative virtual colonoscopy and curative surgery after the diagnosis of a colorectal adenocarcinoma between November 2008 and August 2013 were pooled. We compared the result of conventional colonoscopy with that of virtual colonoscopy in the nonobstructive group and the results of preoperative virtual colonoscopy with that of postoperative colonoscopy performed at 6 months after surgery in the obstructive group. RESULTS: Of the 164 patients, 108 were male and 56 were female patients. The mean age was 62.7 years. The average sensitivity, specificity, and accuracy of virtual colonoscopy for all patients were 31.0%, 67.2%, and 43.8%, respectively. In the nonobstructive group, the average sensitivity, specificity, and accuracy were 36.6%, 66.2%, and 48.0%, respectively, whereas in the obstructive group, they were 2%, 72.4%, and 25.4%. Synchronous cancer was detected via virtual colonoscopy in 4 of the 164 patients. CONCLUSION: Virtual colonoscopy may not be an effective method for the detection of proximal colon polyps, but it can be helpful in determining the therapeutic plan when its results are correlated with the results of other studies.

Detection of Polyps After Resection of Colorectal Cancer.

PURPOSE: Because colonoscopy after colorectal cancer surgery is important for detecting synchronous or metachronous colorectal neoplasms, we designed this study to investigate, by using postoperative colonoscopy, the miss rate for and the location of polyps remaining after colorectal cancer surgery. METHODS: In a prospectively-collected patient database, 264 patients were shown to have undergone a colorectal cancer resection between May 2012 and June 2013. Of these, 116 who had received a complete colonoscopy preoperatively and postoperatively were included in this study. RESULTS: Of these 116 patients, 68 were males and 48 were females; their mean age was 63 years. The mean time after surgery at which postoperative colonoscopy was performed was 7.1 months (range, 3-15 months). On postoperative colonoscopy, a total of 125 polyps were detected. Of these, there were no cancerous lesions; 46 (36.8%) were neoplastic polyps, and 79 (63.2%) were nonneoplastic polyps. Fifty-nine polyps (47.2%) and 15 polyps (12%) were located in the proximal and the distal parts of the anastomosis, respectively. The miss rates for the total numbers of polyps and of neoplastic polyps remaining after surgery were 37.4% and 24.2%, respectively. The incidence of neoplastic polyps increased during postoperative colonoscopy as it had during preoperative colonoscopy (r = 0.164, P = 0.048). CONCLUSION: Colonoscopic surveillance after colorectal cancer resection results in the detection of pathologic polyps in one-fourth of the cases. During postoperative colonoscopy, careful examination of the proximal colon is necessary. Patients in whom multiple neoplastic polyps had been detected during preoperative colonoscopy require careful and thorough follow-up.

Undetermined Margins After Colonoscopic Polypectomy for Malignant Polyps: The Need for Radical Resection.

AIM: The aim of the present study was to analyze the clinicopathological features of patients with colorectal cancer (CRC) who underwent radical operation after malignant polyp removal by colonoscopic procedure. PATIENTS AND METHODS: Between 2009 and 2013, radical colorectal resection was performed in 50 patients with CRC after colonoscopic polypectomy. RESULTS: Nine cases (18%) had residual cancer. Lymph node (LN) metastasis was found in three cases (6.0%) and tumor deposit without LN metastasis (N1c) was found in two cases (4.0%). The indications for radical operation were an undetermined resection margin (23 cases), positive lateral margin (15 cases). Out of the nine cases with residual cancer, five cases had LN metastasis or tumor deposit without residual tumor in the main lesion. One-fourth of cases with an undetermined margin had residual cancer (six out of 23 cases), three of whom had stage III disease. CONCLUSION: Undetermined margins may be considered as an indication for additional radical operation.

Differences in central serotoninergic transmission among patients with recent onset, sub-chronic, and chronic schizophrenia as assessed by the loudness dependence of auditory evoked potentials.

Previous research has shown that abnormalities in serotonin systems are associated with schizophrenia. The loudness dependence of auditory evoked potentials (LDAEP) has been used as a metric of central serotonin activity. The present study aimed to evaluate LDAEP in patients with schizophrenia of differing chronicity. Sixty-four patients with schizophrenia and 50 healthy controls were enrolled in this study. LDAEP and psychometric ratings, such as the positive and negative syndrome scale (PANSS), were measured. The cohort was stratified into three subgroups according to the duration of illness: recent onset (<2years, n=21), sub-chronic (2-9years, n=28), and chronic (≥10years, n=15) groups. The LDAEP differed significantly among the three groups. A post-hoc analysis (Bonferroni) demonstrated that the LDAEP differed significantly between the recent onset and chronic groups (p=0.029), and between the healthy control and chronic groups (p=0.008). Age, sex, dosage of antipsychotics, and smoking did not significantly affect the group differences. In the correlation analysis, there was a significant correlation of LDAEP values with illness duration (r=-0.259, p=0.045). The present study verifies that the LDAEP is related to the duration of illness in patients with schizophrenia. This suggests that central serotonin neurotransmission is changeable, and it may depend on the chronicity of schizophrenia pathology.

Insertion of totally implantable central venous access devices by surgeons.

PURPOSE: The aim of this study is to evaluate the results for the insertion of totally implantable central venous access devices (TICVADs) by surgeons. METHODS: Total 397 patients, in whom TICVADs had been inserted for intravenous chemotherapy between September 2008 and June 2014, were pooled. This procedure was performed under local anesthesia in an operation room. The insertion site for the TICVAD was mainly in the right-side subclavian vein. In the case of breast cancer patients, the subclavian vein opposite the surgical site was used for insertion. RESULTS: The 397 patients included 73 males and 324 females. Primary malignant tumors were mainly colorectal and breast cancer. The mean operation time was 54 minutes (18-276 minutes). Operation-related complications occurred in 33 cases (8.3%). Early complications developed in 15 cases with catheter malposition and puncture failure. Late complications, which developed after 24 hours, included inflammation in 6 cases, skin necrosis in 6 cases, hematoma in 3 cases, port malfunction in 1 case, port migration in 1 case, and intractable pain at the port site in 1 case. CONCLUSION: Insertion of a TICVAD under local anesthesia by a surgeon is a relatively safe procedure. Meticulous undermining of the skin and carefully managing the TICVAD could minimize complications.

Indeterminate pulmonary nodules in colorectal cancer.

AIM: To investigate the clinicopathologic parameters of pulmonary metastasis in colorectal cancer (CRC) patients after lung operation of indeterminate pulmonary nodules (IPNs). METHODS: From a prospective database of CRC patients, 40 cases that underwent lung operation between November 2008 and December 2012 for suspicious metastatic pulmonary nodules on chest computed tomography (CT) were enrolled. The decision to perform a lung operation was made if the patient met the following criteria: (1) completely resected or resectable primary CRC; (2) completely resectable IPNs; (3) controlled or controllable extrapulmonary metastasis; and (4) adequate general condition and pulmonary function to tolerate pulmonary operation. Lung operation was performed by a thoracic surgeon without CT-guided biopsy for pathologic confirmation. RESULTS: A total of 40 cases of lung resection was performed in 29 patients. Five patients underwent repeated lung resection. The final pathology result showed metastasis from the CRC in 30 cases (75%) and benign pathology in 10 cases (25%). The primary tumor site was the rectum in 26/30 (86.6%) cases with pulmonary metastasis, but only 3/10 (30%) cases in the benign group had a primary rectal cancer (P = 0.001). Positron emission tomography (PET)-CT was performed for 22/30 (73.4%) patients in the lung metastasis group and for 6/10 (60.0%) patients in the benign group. PET-CT revealed hot uptake of (18)fluorine 2-fluoro-2-deoxy-D-glucose with all IPNs in both groups. The group with pulmonary metastasis had a higher incidence of primary rectal cancer (P = 0.001), a more advanced tumor stage (P = 0.011), and more frequent lymphatic invasion of tumor cells (P = 0.005). Six cases with previous liver metastasectomy were present in the lung metastasis group. Serum carcinoembryonic antigen levels before lung operation were not elevated in any of the patients. CONCLUSION: The stage and location of the primary tumor and tumor cell infiltration of lymphatics provide useful indicators for deciding on lung resection of IPNs in CRC.

Small bowel diverticulosis in patient with early gastric cancer.

Jejunal and ileal diverticula are rare in adults. Duodenal diverticula are five times more prevalent than jejunoileal diverticula. Most patients are asymptomatic. However, chronic symptoms including intermittent abdominal pain, flatulence, diarrhea and constipation are seen in 10%-30% of patients. Gastric cancer is the second most common cancer in South Korea and here we report a case of early gastric cancer with multiple duodenal and jejunal diverticula. A 67-year-old woman was admitted to Konkuk University Medical Center with chronic diarrhea and weight loss of 19 kg over 2 months. Following gastroduodenoscopy, we identified adenocarcinoma of the lower body of the stomach. On abdominopelvic computed tomography, diverticula of duodenum and jejunum were found. Patient underwent distal gastrectomy and gastroduodenostomy with lymphadenectomy. She was discharged on the tenth postoperative day without complications.