Clinical study of a new skin antiseptic olanexidine gluconate in gastrointestinal cancer surgery.

BACKGROUND: Surgical site infection (SSI) is a common complication of gastrointestinal surgery. Olanexidine gluconate (OLG) is a novel skin antiseptic that is effective against a wide range of bacteria. The purpose of this study was to evaluate the bactericidal efficacy of OLG in gastrointestinal cancer surgery. METHODS: This retrospective study included a total of 281 patients who underwent gastrointestinal cancer surgery (stomach or colon). The patients were divided into two groups: 223 patients were treated with OLG (OLG group), and 58 patients were treated with povidone-iodine (PVP-I) (control group). The efficacy and safety outcomes were measured as the rate of SSI within 30 days after surgery. In addition, we conducted subgroup analyses according to the surgical approach (open or laparoscopic) or primary lesion (stomach or colon). RESULTS: There was a significant difference in the rate of SSI between the control group and OLG group (10.3% vs. 2.7%; p = 0.02). There was a significant difference in the SSI rate in terms of superficial infection (8.6% vs. 2.2%; p = 0.0345) but not in deep infection (1.7% vs. 0.5%; p = 0.371). There was no significant difference between the control group and OLG group in the overall rate of adverse skin reactions (5.2% vs. 1.8%; p = 0.157). CONCLUSION: This retrospective study demonstrates that OLG is more effective than PVP-I in preventing SSI during gastrointestinal cancer surgery.

Synthesis of a Ni Complex Chelated by a [2.2]Paracyclophane-Functionalized Diimine Ligand and Its Catalytic Activity for Olefin Oligomerization.

A diimine ligand having two [2.2]paracyclophanyl substituents at the N atoms (L1) was prepared from the reaction of amino[2.2]paracyclophane with acenaphtenequinone. The ligand reacts with NiBr2(dme) (dme: 1,2-dimethoxyethane) to form the dibromonickel complex with (R,R) and (S,S) configuration, NiBr2(L1). The structure of the complex was confirmed by X-ray crystallography. NiBr2(L1) catalyzes oligomerization of ethylene in the presence of methylaluminoxane (MAO) co-catalyst at 10-50 °C to form a mixture of 1- and 2-butenes after 3 h. The reactions for 6 h and 8 h at 25 °C causes further increase of 2-butene formed via isomerization of 1-butene and formation of hexenes. Reaction of 1-hexene catalyzed by NiBr2(L1)-MAO produces 2-hexene via isomerization and C12 and C18 hydrocarbons via oligomerization. Consumption of 1-hexene of the reaction obeys first-order kinetics. The kinetic parameters were obtained to be ΔG‡ = 93.6 kJ mol-1, ΔH‡ = 63.0 kJ mol-1, and ΔS‡ = -112 J mol-1deg-1. NiBr2(L1) catalyzes co-dimerization of ethylene and 1-hexene to form C8 hydrocarbons with higher rate and selectivity than the tetramerization of ethylene.

Cyclopolymerizations: Synthetic Tools for the Precision Synthesis of Macromolecular Architectures.

Monomers possessing two functionalities suitable for polymerization are often designed and utilized in syntheses directed to the formation of cross-linked macromolecules. In this review, we give an account of recent developments related to the use of such monomers in cyclopolymerization processes, in order to form linear, soluble macromolecules. These processes can be activated by means of radical, ionic, or transition-metal mediated chain-growth polymerization mechanisms, to achieve cyclic moieties of variable ring size which are embedded within the polymer backbone, driving and tuning peculiar physical properties of the resulting macromolecules. The two functionalities are covalently linked by a "tether", which can be appropriately designed in order to "imprint" elements of chemical information into the polymer backbone during the synthesis and, in some cases, be removed by postpolymerization reactions. The two functionalities can possess identical or even very different reactivities toward the polymerization mechanism involved; in the latter case, consequences and outcomes related to the sequence-controlled, precision synthesis of macromolecules have been demonstrated. Recent advances in new initiating systems and polymerization catalysts enabled the precision syntheses of polymers with regulated cyclic structures by highly regio- and/or stereoselective cyclopolymerization. Cyclopolymerizations involving double cyclization, ring-opening, or isomerization have been also developed, generating unique repeating structures, which can hardly be obtained by conventional polymerization methods.

Synthesis and Field-Effect Transistor Application of π-Extended Lactam-Fused Conjugated Oligomers obtained by Tandem Direct Arylation.

Five π-extended lactam-fused conjugated oligomers (5FO, 5FS, 4FPO, 4FPS, and R-4FPO) were synthesized by the tandem direct arylation. The intermolecular oxidative direct arylation was applied in the second step. These conjugated oligomers had fine-tuned FMO energies predictable by the theoretical calculation and excellent thermal stabilities. 4FPO and 4FPS bearing tetrafluoropyridine exhibited lower LUMO energy levels (-3.20 eV and -3.39 eV, respectively) compared with others. Based on the X-ray crystallography, 4FPO was found to have a herringbone crystal packing and a considerably large electron transfer integral value (137 meV). 4FPO-based bottom-gate, bottom-contact FET device demonstrated an electron mobility of 5.2×10-3  cm2 V-1 s-1 as a result of an edge-on alignment on the SiO2 substrate.

Creating Elastic Organic Crystals of π-Conjugated Molecules with Bending Mechanofluorochromism and Flexible Optical Waveguide.

To create low band-gap, fluorescent, and elastic organic crystal emitters, we focused on an extended π-conjugated system based on: a) a planar conformation,b) a rigid structure, and c) controlled intermolecular interactions. Herein, we report on two fluorescent and highly flexible organic crystals (1 and 2) which could bend under an applied stress. The bent crystals rapidly recover their straight shape upon release of the stress. Crystal 1 with a tetrafluoropyridyl terminal unit and a lower band-gap energy (orange emission, λem =573 nm, ΦF =0.50), showed no bending mechanofluorochromism and had superior performance as an optical waveguide with reddish orange emission. The waveguide performance of the crystal did not decrease under bending stress. For crystal 2 with a pentafluorophenyl terminal unit (green emission, λem =500 nm, ΦF =0.38), the original waveguide performance decreased under an applied bending stress; however, this crystal showed a unique bending mechanofluorochromism.

Factors related to dementia patients' length of day-care clinic attendance.

BACKGROUND: In our previous study, we reported that patients using a day-care clinic for less than 1 year were older than those who continued day-care activities for more than 1 year. We found that dementia symptoms, as assessed by caregivers using the initial Assessment Scale for Symptoms of Dementia score, influenced the length of day-care clinic attendance (LDC). However, these results were obtained by univariate analysis. In this study, we investigated the factors that influenced LDC using multivariate analysis. METHODS: We studied data from 457 patients with dementia who attended our day-care clinic for dementia patients from 1 April 2000 to 31 March 2012 and continued intervention until 31 March 2013. We evaluated the factors that influenced LDC using Cox's proportional hazards model for each sex. RESULTS: Kaplan-Meier analysis showed a gender difference in LDC. The median LDC was 18 months (interquartile range: 3-37 months) for men and 21 months (interquartile range: 5-53 months) for women (P = 0.027). In model 1, the low initial Assessment Scale for Symptoms of Dementia score for each sex and high initial scores for Hasegawa's Dementia Scale-Revised and Nishimura's activity of daily living scale in women were related to the long-term use of day care. Model 2 indicated that a low final score for Nishimura's activity of daily living scale increased LDC for each sex. LDC was not affected by variables related to the caregiving system except for the number of cohabitants in men. CONCLUSIONS: It was suggested that patients with high cognitive and physical functions attend the day-care clinic for a long time. It was necessary to control the behavioural and psychological symptoms of dementia for those using day care in the long term. However, patients with low physical function at the end of day-care attendance may also attend our day-care service in the long term if they receive favourable assistance.

Synthesis of Optically Active Polystyrene Catalyzed by Monophosphine Pd Complexes.

Cationic Pd(II) monophosphine complexes derived from α- and ß-cyclodextrins (CDs) promote the homopolymerization of styrene under carbon monoxide pressure. Although reversible CO coordination takes place under catalytic conditions according to (13) C NMR studies with (13) C-enriched CO, both complexes catalyze the formation of CO-free styrene polymers. These macromolecules display optical activity as a result of the presence of stereoregular sequences within the overall atactic polymer.

Olefin Polymerization Catalyzed by Double-Decker Dipalladium Complexes: Low Branched Poly(α-Olefin)s by Selective Insertion of the Monomer Molecule.

Dipalladium complexes of a cyclic bis(diimine) ligand with a double-decker structure catalyze polymerization of ethylene and α-olefins and copolymerization of ethylene with 1-hexene. The polymerization of 1-hexene yields a polymer that is mainly composed of the hexamethylene unit formed by 2,1-insertion of the monomer into the palladium-carbon bond, followed by chain-walking (6,1-insertion). The polymerization of 4-methyl-1-pentene proceeds by 2,1-insertion with a selectivity of 92-97 %, and affords the polymer with methyl and 2-methylhexyl branches. 2,1-Insertion occurs selectively in all of the polymerization reactions of α-olefins catalyzed by the dipalladium complexes. Ethylene polymerization with the catalyst at 100 °C lasts over 24 h, whereas the monopalladium-diimine catalyst loses its activity within 8 h at 60 °C. Polyethylene obtained by the dipalladium catalyst is less-branched and has a higher molecular weight compared to that of the monopalladium catalyst under the same conditions. Copolymerization of ethylene with 1-hexene affords solid products with melting points and molecular weights that vary depending on the polymerization time, suggesting formation of a block and/or gradient copolymer.

Postoperative complications in elderly patients with gastric cancer.

BACKGROUND: Elderly patients undergoing gastrectomy are expected to be at high risk of postoperative complications. This retrospective multicenter cohort study assessed complications and long-term outcomes after gastrectomy for gastric cancer (GC). METHODS: A total of 993 patients with GC who had undergone gastrectomy were included, comprising 186 elderly patients (age ≥ 80 y, E group) and 807 nonelderly patients (age ≤ 79 y, NE group). Preoperative comorbidities, operative results, postoperative complications, and clinical outcomes were compared between the groups. RESULTS: Clavien-Dindo grade ≥1 postoperative complications, pneumonia (P = 0.02), delirium (P < 0.001), and urinary tract infection (P < 0.001) were more common in the E group. Postoperative pneumonia was associated with mortality in this group (P < 0.001). Three patients (1.6%) died after surgery, each of whom had pneumonia. Severe postoperative complication was independently prognostic of overall (hazard ratio, 4.69; 95% confidence interval, 2.40-9.14; P < 0.001) and disease-specific (hazard ratio, 6.41; 95% confidence interval 2.92-14.1; P < 0.001) survival in the E group. CONCLUSIONS: In elderly patients with GC, clinical outcomes are strongly associated with severe postoperative complications. Preventing such complications may improve survival.

Prevalence of synchronous colorectal neoplasms in surgically treated gastric cancer patients and significance of screening colonoscopy.

BACKGROUND AND AIM: The existence of other primary tumors during the treatment and management of gastric cancer (GC) is an important issue. The present study investigated the prevalence and management of synchronous colorectal neoplasms (CRN) in surgically treated GC patients. METHODS: Of 381 surgically treated GC patients, 332 (87.1%) underwent colonoscopy to detect CRN before surgery or within a year after surgery. RESULTS: CRN were synchronously observed in 140 patients (42.2%). Adenoma was observed in 131 patients (39.4%). Endoscopic resection was done in 18 patients with adenoma. Colorectal cancer (CRC) was observed in 16 patients (4.8%), superficial CRC in 13 and advanced CRC in three patients. Endoscopic resection of superficial CRC was carried out in seven patients, whereas simultaneous surgical resection of CRC was done in nine patients. CRN were more frequently observed in men. CRC was more frequently observed in GC patients with distant metastasis, albeit without significance. The overall survival of GC patients with CRN or CRC was poorer than that of patients without CRN or CRC. CONCLUSION: Synchronous CRN were commonly associated with GC and screening colonoscopy should be offered to patients with GC.

Factors related to day-care clinic outcomes for dementia patients: differences between hospitalization in the dementia ward and institutionalization.

BACKGROUND: Few reports have investigated factors related to the outcomes of day-care attendance. The aim of this retrospective study was to investigate the factors related to the outcomes of patients who attended day-care clinics, with special attention to the differences between hospitalization in the dementia ward and institutionalization. METHODS: We analyzed data from 333 patients in consecutive cases who attended day care between 1 April 2000 and 31 March 2010 and then followed them until 31 March 2011. For univariate and multivariate analyses, patients were divided into seven groups characterized by their outcomes: (i) patients who continued day-care attendance (continued); (ii) those hospitalized for physical problems (hospital (physical)); (iii) those hospitalized in the dementia ward (ward (dementia)); (iv) those hospitalized in the psychiatric ward for psychiatric problems (ward (psychiatric)); (v) those institutionalized (institution); (vi) those who stopped day-care attendance by choice (intention); and (vii) those who stopped day-care attendance for other or unknown reasons (others). RESULTS: Behavioural and psychological symptoms of dementia were the main reasons for hospitalization and institutionalization. Men were easier to hospitalize in the dementia ward. Patients who applied for insurance were more likely to be institutionalized. The differences between patients who were hospitalized (dementia ward) and institutionalized were age and cognitive function. CONCLUSIONS: Patients who were older and had high cognitive function were institutionalized rather than hospitalized in the dementia ward. Patients with severe dementia symptoms were advised to be treated in the dementia ward.

Dipalladium catalyst for olefin polymerization: introduction of acrylate units into the main chain of branched polyethylene.

A dipalladium complex with a double-decker structure catalyzes ethylene-acrylate copolymerization to produce the branched polymer containing the acrylate units in the polymer chain, not at the branch terminus. The cooperation of the two palladium centers, which are fixed in a rigid framework of the macrocyclic ligand, is proposed to have a significant dinuclear effect on the copolymerization.

Diabetes-accelerated memory dysfunction via cerebrovascular inflammation and Abeta deposition in an Alzheimer mouse model with diabetes.

Recent epidemiological studies suggest that diabetes mellitus is a strong risk factor for Alzheimer disease. However, the underlying mechanisms remain largely unknown. In this study, to investigate the pathophysiological interaction between these diseases, we generated animal models that reflect the pathologic conditions of both diseases. We crossed Alzheimer transgenic mice (APP23) with two types of diabetic mice (ob/ob and NSY mice), and analyzed their metabolic and brain pathology. The onset of diabetes exacerbated Alzheimer-like cognitive dysfunction without an increase in brain amyloid-beta burden in double-mutant (APP(+)-ob/ob) mice. Notably, APP(+)-ob/ob mice showed cerebrovascular inflammation and severe amyloid angiopathy. Conversely, the cross-bred mice showed an accelerated diabetic phenotype compared with ob/ob mice, suggesting that Alzheimer amyloid pathology could aggravate diabetes. Similarly, APP(+)-NSY fusion mice showed more severe glucose intolerance compared with diabetic NSY mice. Furthermore, high-fat diet feeding induced severe memory deficits in APP(+)-NSY mice without an increase in brain amyloid-beta load. Here, we created Alzheimer mouse models with early onset of cognitive dysfunction. Cerebrovascular changes and alteration in brain insulin signaling might play a pivotal role in this relationship. These findings could provide insights into this intensely debated association.

[A case of squamous cell carcinoma of the esophagogastric junction with bulky no.7-metastatic node successfully treatedby chemoradiation followed by surgery].

The patient was a 59-year-old man showing an ulcerative tumor. He had squamous cell carcinoma diagnosed by biopsy specimens, found in the esophagogastric junction by esophagogastroduodenoscopy. Abdominal CT showed a No.7 nodeswelling( 40mm in diameter), and the metastatic tumor directly invaded the pancreas(cStage IVa). We scheduled surgery followed by chemoradiotherapy, because it was difficult to remove the metastatic node completely. Two courses of chemotherapy consisting of 5-FU and CDDP were performed, and 2 Gy/day-irradiation(total amount of 40 Gy)was performed over 20 days. After chemoradiation, the tumor changed to a superficially depressed lesion, and the metastatic huge node was shrunk. Thirty-five days after chemoradiation, transhiatal a lower esophagectomy with proximal gastrectomy was performed. Histopathologic findings after surgery showed no cancer remnant in the primary site and the node(pCR). Three years later, the patient is well without recurrence. Although there was no evidence of preoperative chemoradiation limited in squamous cell carcinoma of the esophagogastric junction, surgery followed by chemoradiotherapy may be an effective treatment in advanced cases, such as the present one.

Ocular and extraocular sebaceous carcinomas: A retrospective study with emphasis on the presence of in situ lesion and discussion and review of the histogenesis of extraocular sebaceous carcinoma.

Sebaceous carcinoma (SC) is a rare carcinoma classified as ocular or extraocular. Ocular SC is believed to arise from the meibomian glands or the glands of Zeis. However, the origin of extraocular SC is controversial because there is no evidence of carcinoma arising from pre-existing sebaceous glands. Several hypotheses about the origin of extraocular SC have been proposed, including one suggesting an origin from intraepidermal neoplastic cells. Although extraocular SCs have been shown to occasionally comprise intraepidermal neoplastic cells, no study has investigated whether intraepidermal neoplastic cells possess sebaceous differentiation. The present study analyzed the clinicopathological features of ocular and extraocular SC, with an emphasis on the presence of in situ (intraepithelial) lesions. It retrospectively reviewed the clinicopathological features of eight patients with ocular and three patients with extraocular SC (eight women and three men; median age, 72 years), respectively. In situ (intraepithelial) lesions were observed in four of the eight ocular SC cases and one of the three extraocular SC cases and an apocrine component was noted in one patient with ocular SC (seboapocrine carcinoma). In addition, immunohistochemical analyses showed that the androgen receptor (AR) was expressed in all ocular SCs and two of the three extraocular SC cases. Adipophilin expression was observed in all ocular and extraocular SC. In situ lesions of extraocular SC showed positive immunoreactivity for both AR and adipophilin. The present study is the first to demonstrate sebaceous differentiation in in situ lesions of extraocular SC. The possible origin of extraocular SC is speculated to be the progenitor cells present in the sebaceous duct or interfollicular epidermis. The results of the present study and reported cases of SC in situ indicate that extraocular SC also arises from intraepidermal neoplastic cells.

Ethylene polymerization using N-Heterocyclic carbene complexes of silver and aluminum.

Various transition metal catalysts have been utilized for ethylene polymerization. Silver catalysts have attracted less attention as the catalysts, but are potential for production of high molecular weight polyethylene. Herein, we report that silver complexes with various N-heterocyclic carbene (NHC) ligands in combination with modified methylaluminoxane (MMAO) afford polyethylene with high molecular weight (melting point over 140°C). SEM observation showed that the produced polyethylene has ultra-high molecular weight. NMR investigation of the reaction between the silver complexes with organoaluminums indicate that the NHC ligands transfer from the silver complex to aluminum to produce NHC aluminum complexes. Ph3C[B(C6F5)4] abstract methyl group from the NHC aluminum complex to afford cationic aluminum complex. The NHC aluminum complex promoted ethylene polymerization in the presence of Ph3C[B(C6F5)4] and organoaluminums. NHC ligand also promoted ethylene polymerization in combination with MMAO to produce polyethylene with high melting point (140.7°C). Thus, the aluminum complexes are considered to be the actual active species in silver-catalyzed ethylene polymerization.

Successful selective production of vanillic acid from depolymerized sulfite lignin and its application to poly(ethylene vanillate) synthesis.

Towards lignin upgrading, vanillic acid (VA), a lignin-derived guaiacyl compound, was produced from sulfite lignin for successfully synthesizing poly(ethylene vanillate), an aromatic polymer. The engineered Sphingobium sp. SYK-6-based strain in which the genes responsible for VA/3-O-methyl gallic acid O-demethylase and syringic acid O-demethylase were disrupted was able to produce vanillic acid (VA) from the mixture consisting of acetovanillone, vanillin, VA, and other low-molecular-weight aromatics obtained by Cu(OH)2-catalyzed alkaline depolymerization of sulfite lignin and membrane fractionation. From the bio-based VA, methyl-4-(2-hydroxyethoxy)-3-methoxybenzoate was synthesized via methylesterification, hydroxyethylation, and distillation, and then it was subjected to polymerization catalyzed by titanium tetraisopropoxide. The molecular weight of the obtained poly(ethylene vanillate) was evaluated to be Mw = 13,000 (Mw/Mn = 1.99) and its melting point was 261 °C. The present work proved that poly(ethylene vanillate) is able to be synthesized using VA produced from lignin for the first time.

Strained and unstrained macrocycles composed of carbazole and butadiyne units: electronic state and optical properties.

Cu(OAc)(2) catalyzes dehydrogenative condensation of 3,6-bis(2-ethynylphenyl)carbazole in the presence of O(2) to afford the cyclization product 1 and cyclodimer 2. Compound 1 contains bent carbazole and butadiyne groups, while 2 has a less strained structure with Z shape around the two parallel butadiyne groups. Optical properties of the compounds are discussed based on the electronic states estimated from electrochemical measurement and density functional theory calculation.

Mediastinoscopy-assisted esophagectomy for esophageal cancer in patients with serious comorbidities.

PURPOSE: We evaluated the results of mediastinoscopy-assisted esophagectomy (MAE), performed for esophageal cancer patients with comorbidities, versus those of thoracoscopic esophagectomy (TSE), performed for esophageal patients with or without comorbidities. METHODS: Among 153 patients who underwent esophageal cancer surgery at our hospital, 17 (11.1%) underwent MAE and 37 (24.2%) underwent TSE. RESULTS: Many of the MAE group patients had pulmonary (P < 0.001), cardiovascular (P = 0.031), or hepatic (P = 0.0029) diseases preoperatively, and these comorbidities frequently overlapped (P < 0.0001). The %VC and FEV(1)/FVC were lower (P = 0.0099 and P = 0.0057, respectively), and the ICG-R15 and serum level of HbA1c were higher (P = 0.0014 and P = 0.043, respectively) in the MAE group. There were no differences in postoperative complications or in the modified Clavien classification between the groups. There was no mortality in either group. After MAE, 5 (29.4%) patients died of other diseases. The 5-year overall survival rate after MAE was poorer than that after TSE (56.1 vs. 71.8%), but the 5-year cause-specific survival rates were similar in the two groups. CONCLUSIONS: MAE is feasible for esophageal cancer patients with serious comorbidities and may decrease morbidity and mortality.

Smooth muscle degeneration of the mesenteric and branching veins causing ischemic enteritis: a case report.

BACKGROUND: Ischemic bowel injuries are generally caused by arteriosclerosis, thromboembolism, or vasculitis. Ischemic enteritis is less common than ischemic colitis because of the rich collateral arteries of the small intestine. In the present case, smooth muscle degeneration of the mesenteric to the submucosal veins caused ischemic enteritis and small bowel obstruction. CASE PRESENTATION: An 85-year-old woman with recurrent enteritis eventually developed small bowel obstruction. We performed laparoscopic partial resection of the small intestine. The pathological findings revealed smooth muscle degeneration of the mesenteric veins that caused ischemic enteritis. Venous changes were detected not only in the injured region, but also in a part of the normal region of the resected specimen. She continued to experience some minor symptoms postoperatively; however, these symptoms subsided in a short period with medicine discontinuation. CONCLUSION: This report shows the possibility that a disease causes ischemic enteritis with unique venous pathological changes and may recur postoperatively.