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Although numerous studies have shown the ability of silicon (Si) to mitigate a wide variety of abiotic and biotic stresses, relatively little is known about the underlying mechanism(s). Here, we have investigated the role of hormone defense pathways in Si-induced resistance to the rice brown spot fungus Cochliobolus miyabeanus. To delineate the involvement of multiple hormone pathways, a multidisciplinary approach was pursued, combining exogenous hormone applications, pharmacological inhibitor experiments, time-resolved hormone measurements, and bioassays with hormone-deficient and/or -insensitive mutant lines. Contrary to other types of induced resistance, we found Si-induced brown spot resistance to function independently of the classic immune hormones salicylic acid and jasmonic acid. Our data also rule out a major role of the abscisic acid (ABA) and cytokinin pathways, but suggest that Si mounts resistance to C. miyabeanus by preventing the fungus from hijacking the rice ethylene (ET) machinery. Interestingly, rather than suppressing rice ET signaling per se, Si probably interferes with the production and/or action of fungal ET. Together our findings favor a scenario whereby Si induces brown spot resistance by disarming fungal ET and argue that impairment of pathogen virulence factors is a core resistance mechanism underpinning Si-induced plant immunity.
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Ascomicetos/fisiología , Etilenos/metabolismo , Oryza/efectos de los fármacos , Enfermedades de las Plantas/inmunología , Reguladores del Crecimiento de las Plantas/metabolismo , Silicio/farmacología , Resistencia a la Enfermedad , Interacciones Huésped-Patógeno , Oryza/inmunología , Oryza/microbiología , Enfermedades de las Plantas/microbiología , Hojas de la Planta/efectos de los fármacos , Hojas de la Planta/inmunología , Hojas de la Planta/microbiología , Transducción de SeñalRESUMEN
Background Screening tests reveal the early signs of cognitive decline, enabling better self-care and preparation for the future. We developed and evaluated the accuracy of a rapid (20 s) and easy-to-use tool called ONSEI, assessing the cognitive decline equivalent to dementia in actual clinical practice by correlating clinical diagnoses with the ONSEI classification. Methods In this retrospective observational study, data were collected from individuals who visited three neurosurgical clinics in neighboring prefectures of Tokyo, Japan. ONSEI analysis was performed using a smartphone or tablet. The tool adopts a machine-learning algorithm using the speaker's age, time-orientation task score, and acoustic features of spoken responses to that task. Significant differences in accuracy, sensitivity, and specificity were evaluated by Fisher's exact test. Results The overall classification accuracy of ONSEI was 98.1% (p<0.001). The sensitivity and specificity were 97.3% (p<0.001) and 98.5% (p<0.001), respectively. The proportion of correct classifications was consistent across different age groups. Conclusion ONSEI showed high classification accuracy for dementia in cognitively normal individuals in actual clinical practice, regardless of the facility at which the tests were conducted or the age of the participants. Thus, ONSEI can be useful for dementia screening and self-care.
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Calcium-dependent protein kinases (CDPKs) regulate the downstream components in calcium signaling pathways. We investigated the effects of overexpression and disruption of an Oryza sativa (rice) CDPK (OsCPK12) on the plant's response to abiotic and biotic stresses. OsCPK12-overexpressing (OsCPK12-OX) plants exhibited increased tolerance to salt stress. The accumulation of hydrogen peroxide (H(2) O(2) ) in the leaves was less in OsCPK12-OX plants than in wild-type (WT) plants. Genes encoding reactive oxygen species (ROS) scavenging enzymes (OsAPx2 and OsAPx8) were more highly expressed in OsCPK12-OX plants than in WT plants, whereas the expression of the NADPH oxidase gene, OsrbohI, was decreased in OsCPK12-OX plants compared with WT plants. Conversely, a retrotransposon (Tos17) insertion mutant, oscpk12, and plants transformed with an OsCPK12 RNA interference (RNAi) construct were more sensitive to high salinity than were WT plants. The level of H(2) O(2) accumulation was greater in oscpk12 and OsCPK12 RNAi plants than in the WT. These results suggest that OsCPK12 promotes tolerance to salt stress by reducing the accumulation of ROS. We also observed that OsCPK12-OX seedlings had increased sensitivity to abscisic acid (ABA) and increased susceptibility to blast fungus, probably resulting from the repression of ROS production and/or the involvement of OsCPK12 in the ABA signaling pathway. Collectively, our results suggest that OsCPK12 functions in multiple signaling pathways, positively regulating salt tolerance and negatively modulating blast resistance.
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Proteínas Quinasas Dependientes de Calcio-Calmodulina/metabolismo , Magnaporthe/patogenicidad , Oryza/microbiología , Oryza/fisiología , Proteínas de Plantas/metabolismo , Ácido Abscísico/metabolismo , Ácido Abscísico/farmacología , Ascorbato Peroxidasas/genética , Proteínas Quinasas Dependientes de Calcio-Calmodulina/genética , Resistencia a la Enfermedad , Regulación Enzimológica de la Expresión Génica , Regulación de la Expresión Génica de las Plantas , Peróxido de Hidrógeno/metabolismo , Mutación , NADPH Oxidasas/genética , Oryza/efectos de los fármacos , Enfermedades de las Plantas/microbiología , Hojas de la Planta/metabolismo , Hojas de la Planta/microbiología , Proteínas de Plantas/genética , Plantas Modificadas Genéticamente , Interferencia de ARN , Especies Reactivas de Oxígeno/metabolismo , Tolerancia a la SalRESUMEN
A case of recurrent pancreatic cancer effectively responded to S-1 and irinotecan combined with third-line chemotherapy (IRIS) with PSK. The patient was a 75-year-old female. In October 2007, a pancreatoduodenectomy was performed, followed with 6 courses of systemic adjuvant chemotherapy of gemcitabine (GEM). Three months after finishing the adjuvant chemotherapy, a recurrence of para-aortic lymph node metastasis was confirmed. We resumed the second-line chemotherapy of S-1/GEM (GS) with PSK. GS therapy was continued for about 3 years, until the recurrent lesion was found to have increased after 30 courses. Nevertheless, we continued up to 39 courses. In November 2011, we started third-line chemotherapy using S-1/irinotecan (IRIS) with PSK. The regimen was S-1 of 80 mg/body/day, continuously administered for day 1-14th, followed by a discontinuation for 2 weeks. CPT-11 100 mg/body/day was administered on day 1 and 15th; and PSK of 3 g/ body/day was continued, until it resulted in increased recurrent lesions. After the end of 4 courses, recurrent lesions started to respond partially. Currently, the patient is being treated as an outpatient. This case indicates that IRIS (S-1/CPT-11) is an effective therapy when pancreatic cancer fails to respond to GS therapy.
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Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Neoplasias Pancreáticas/tratamiento farmacológico , Anciano , Camptotecina/administración & dosificación , Camptotecina/análogos & derivados , Combinación de Medicamentos , Femenino , Humanos , Irinotecán , Metástasis Linfática , Ácido Oxónico/administración & dosificación , Neoplasias Pancreáticas/patología , Neoplasias Pancreáticas/cirugía , Proteoglicanos/administración & dosificación , Recurrencia , Terapia Recuperativa , Tegafur/administración & dosificaciónRESUMEN
Calcium acts as a messenger in various signal transduction pathways in plants. Calcium-dependent protein kinases (CDPKs) play important roles in regulating downstream components in calcium signaling pathways. In rice, the CDPKs constitute a large multigene family consisting of 29 genes, but the biological functions and functional divergence or redundancy of most of these genes remain unclear. Using a mini-scale full-length cDNA overexpressor (FOX) gene hunting system, we generated 250 independent transgenic rice plants overexpressing individual rice CDPKs (CDPK FOX-rice lines). These CDPK FOX-rice lines were screened for salt stress tolerance. The survival rate of the OsCPK21-FOX plants was higher than that of wild-type (WT) plants grown under high salinity conditions. The inhibition of seedling growth by abscisic acid (ABA) treatment was greater in the OsCPK21-FOX plants than in WT plants. Several ABA- and high salinity-inducible genes were more highly expressed in the OsCPK21-FOX plants than in WT plants. These results suggest that OsCPK21 is involved in the positive regulation of the signaling pathways that are involved in the response to ABA and salt stress.
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Oryza/genética , Proteínas de Plantas/genética , Proteínas Quinasas/genética , Tolerancia a la Sal/genética , Ácido Abscísico/farmacología , Frío , Regulación Enzimológica de la Expresión Génica/efectos de los fármacos , Regulación de la Expresión Génica de las Plantas/efectos de los fármacos , Oryza/enzimología , Oryza/crecimiento & desarrollo , Filogenia , Proteínas de Plantas/metabolismo , Plantas Modificadas Genéticamente , Proteínas Quinasas/clasificación , Proteínas Quinasas/metabolismo , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa , Tolerancia a la Sal/fisiología , Plantas Tolerantes a la Sal/genética , Cloruro de Sodio/farmacologíaRESUMEN
BACKGROUND: Plant roots are important organs to uptake soil water and nutrients, perceiving and transducing of soil water deficit signals to shoot. The current knowledge of drought stress transcriptomes in rice are mostly relying on comparative studies of diverse genetic background under drought. A more reliable approach is to use near-isogenic lines (NILs) with a common genetic background but contrasting levels of resistance to drought stress under initial exposure to water deficit. Here, we examined two pairs of NILs in IR64 background with contrasting drought tolerance. We obtained gene expression profile in roots of rice NILs under different levels of drought stress help to identify genes and mechanisms involved in drought stress. RESULTS: Global gene expression analysis showed that about 55% of genes differentially expressed in roots of rice in response to drought stress treatments. The number of differentially expressed genes (DEGs) increased in NILs as the level of water deficits, increased from mild to severe condition, suggesting that more genes were affected by increasing drought stress. Gene onthology (GO) test and biological pathway analysis indicated that activated genes in the drought tolerant NILs IR77298-14-1-2-B-10 and IR77298-5-6-B-18 were mostly involved in secondary metabolism, amino acid metabolism, response to stimulus, defence response, transcription and signal transduction, and down-regulated genes were involved in photosynthesis and cell wall growth. We also observed gibberellic acid (GA) and auxin crosstalk modulating lateral root formation in the tolerant NILs. CONCLUSIONS: Transcriptome analysis on two pairs of NILs with a common genetic background (~97%) showed distinctive differences in gene expression profiles and could be effective to unravel genes involved in drought tolerance. In comparison with the moderately tolerant NIL IR77298-5-6-B-18 and other susceptible NILs, the tolerant NIL IR77298-14-1-2-B-10 showed a greater number of DEGs for cell growth, hormone biosynthesis, cellular transports, amino acid metabolism, signalling, transcription factors and carbohydrate metabolism in response to drought stress treatments. Thus, different mechanisms are achieving tolerance in the two tolerant lines.
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Sequías , Oryza/genética , Raíces de Plantas/genética , Transcriptoma , Regulación de la Expresión Génica de las Plantas , Genotipo , Análisis por Micromatrices , Oryza/metabolismo , Raíces de Plantas/metabolismo , ARN de Planta/genética , Estrés FisiológicoRESUMEN
PURPOSE: Total intersphincteric resection (total ISR) is a surgical option for patients with advanced cancer of the lower rectum. However, anorectal stricture can develop after total ISR, which stretches from the anus to the lower rectum. Conventional anoplasty for anal stricture is often ineffective for them because the areas of stricture are long and the most proximal points of the strictures are too far for advancement flaps or rotation flaps to reach. We have developed a new surgical treatment method using a gluteal-fold flap (GFF) for anal stricture after total ISR. METHODS: From April 2004 through June 2007, hemilateral GFFs were transferred to treat anorectal strictures after total ISR in three patients at the National Cancer Center Hospital East, Chiba, Japan. Postoperative results and anal function were evaluated. RESULTS: In all three patients, GFFs were successfully transferred, and good dilation of the anorectal stenosis was achieved. Postoperative anal function was satisfactory. CONCLUSION: The GFF has a rich vascular supply and can be simply and reliably transferred. We believe that GFF transfer is an excellent option for treating anorectal strictures after total ISR.
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Canal Anal/patología , Canal Anal/cirugía , Nalgas/cirugía , Recto/patología , Recto/cirugía , Colgajos Quirúrgicos , Constricción Patológica , Humanos , Masculino , Persona de Mediana Edad , Cuidados PosoperatoriosRESUMEN
BACKGROUND: The choice of recipient vessels is an important factor for successful head and neck reconstruction. Finding good recipient vessels for neck microsurgery can be difficult after patients have undergone radiation therapy, previous neck dissection or developed neck infections due to pharyngocutaneous fistulae. Thoracoacromial arteries and veins can be good alternatives to common recipient vessels in such patients. We reviewed the complications, advantages and disadvantages associated with using thoracoacromial arteries and veins as recipient vessels. METHODS: We reviewed eight patients whose thoracoacromial arteries and veins served as recipient vessels for head and neck reconstruction between 2002 and 2009. Preoperative status, reconstruction method and operative outcomes with complications were evaluated. RESULTS: Postoperative complications related to microsurgical anastomosis developed in two of the eight patients. One arterial and venous thrombosis developed in each patient. We considered that the arterial thrombosis was derived from a technical problem with the operation and the venous thrombosis was derived from postoperative external pressure. CONCLUSIONS: Thoracoacromial arteries and veins are good recipient vessels for patients who have undergone ablative or reconstructive surgery, radiation therapy, or have a neck infection due to complications. However, we believe that using these vessels as recipients requires specific precautions that differ from those associated with general head and neck reconstruction.
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Acromion/irrigación sanguínea , Procedimientos de Cirugía Plástica/métodos , Colgajos Quirúrgicos/irrigación sanguínea , Arterias Torácicas/trasplante , Anciano , Anciano de 80 o más Años , Anastomosis Quirúrgica , Arterias/trasplante , Femenino , Estudios de Seguimiento , Rechazo de Injerto , Supervivencia de Injerto , Neoplasias de Cabeza y Cuello/patología , Neoplasias de Cabeza y Cuello/cirugía , Humanos , Masculino , Microcirugia/métodos , Persona de Mediana Edad , Complicaciones Posoperatorias/fisiopatología , Complicaciones Posoperatorias/cirugía , Procedimientos de Cirugía Plástica/efectos adversos , Estudios Retrospectivos , Medición de Riesgo , Arterias Torácicas/cirugía , Fístula Vascular/etiología , Fístula Vascular/cirugía , Venas/trasplante , Trombosis de la Vena/etiología , Trombosis de la Vena/terapia , Cicatrización de Heridas/fisiologíaRESUMEN
OBJECTIVES: To evaluate future problems in colorectal cancer surgery for elderly patients. METHODS: We conducted a retrospective review of patients receiving colorectal cancer surgery in our hospital from January 2010 to December 2018. Patients were divided into the ≥ 85-year-old patient group and the younger patient group. We compared patient backgrounds, surgical outcomes (surgical procedure, reduction of lymph node dissection range, operative duration, and blood loss), postoperative short-term outcomes (mortality, morbidity, and postoperative length of stay) and prognosis. RESULTS: We performed colorectal cancer surgery on 1,240 patients during the study period. Of them, 109 (8.7%) were ≥ 85 years old, and 1,131 (91.2%) were < 85 years old. The American Society of Anesthesiologists physical status (ASA-PS) was significantly poorer in the elderly group than in the younger group and patients with a history of cardiac disease and anticoagulant use were significantly more in the elderly group. The rate of reduction of lymph node dissection range was significantly higher in the elderly group (16.8% vs. 3.8%, p < 0.05). Overall morbidity was significantly higher in the elderly group (42.2% vs. 21.9%, p < 0.05), as were the respective frequencies of pneumonia and thromboembolism (8.2% vs. 0.7%, p < 0.05 and 3.6% vs. 0.8%, p < 0.05, respectively). Postoperative hospital stay was significantly longer in the elderly group (17 vs. 12 days, p < 0.05). Overall survival was significantly lower in the elderly group (p < 0.05), but relapse-free survival and colorectal cancer-specific survival were not statistically different between the groups (p = 0.05 and p = 0.15, respectively). CONCLUSIONS: Prevention of postoperative pneumonia and thromboembolism remains a problem. After proper assessment and careful management of peri-operative surgical risks, surgery can be indicated in elderly patients.
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Activator protein-1 (AP-1) regulates the expression of several genes involved in human tumorigenesis. However, there is little known about this transcription factor in pancreatic ductal adenocarcinoma. We recently found high levels of AP-1-binding activities and multiple AP-1/DNA complexes containing c-Jun, JunD, Fra1, and Fra2 in pancreatic cancer cells. Transient transfection assays indicated that AP-1 was functional and capable of transactivating its gene targets. Furthermore, a c-Jun transactivation mutant inhibited anchorage-dependent and anchorage-independent proliferation, suggesting that AP-1 had an essential role in pancreatic cancer cells. Our study also uncovered a novel mechanism by which protein kinase Akt controls c-Jun activity in pancreatic cancer cells. Indeed, distinct from its known ability to induce c-fos and fra1 and to stabilize c-Jun, Akt appeared to directly regulate the transcriptional activity of c-Jun independently of the phosphorylation sites targeted by c-Jun NH(2)-terminal kinase (Ser(63)/Ser(73)) and glycogen synthase kinase-3 (Thr(239)). Our data also suggest that growth factors might use this Akt-regulated mechanism to potently induce c-Jun targets such as cyclin D1. Collectively, our findings indicate that AP-1 has an important function in pancreatic cancer cells and provide evidence for a previously unknown Akt-mediated mechanism of c-Jun activation.
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Proteínas Proto-Oncogénicas c-akt/metabolismo , Transducción de Señal , Factor de Transcripción AP-1/metabolismo , Línea Celular , Línea Celular Tumoral , Proliferación Celular , Proteínas de Unión al ADN/genética , Proteínas de Unión al ADN/metabolismo , Ensayo de Cambio de Movilidad Electroforética , Glucógeno Sintasa Quinasa 3/metabolismo , Humanos , Immunoblotting , Proteínas Quinasas JNK Activadas por Mitógenos/metabolismo , Luciferasas/genética , Luciferasas/metabolismo , Mutación , Neoplasias Pancreáticas/metabolismo , Neoplasias Pancreáticas/patología , Neoplasias Pancreáticas/fisiopatología , Fosfatidilinositol 3-Quinasas/metabolismo , Unión Proteica , Proteínas Proto-Oncogénicas c-jun/genética , Proteínas Proto-Oncogénicas c-jun/metabolismo , Proteínas Recombinantes de Fusión/genética , Proteínas Recombinantes de Fusión/metabolismo , Factor de Transcripción AP-1/genética , Factor de Transcripción AP-1/fisiología , TransfecciónRESUMEN
Rectus abdominis musculocutaneous (RAMC) free flaps are preferred for head and neck reconstruction because of the abundant blood supply to the rectus abdominis musculocutaneous. In contrast, the indications for deep inferior epigastric perforator (DIEP) free flaps in head and neck reconstruction are limited. In this report, two cases of oral cavity reconstruction with DIEP free flaps are described. In both cases, the defect was reconstructed with a DIEP free flap because it could avoid functional damage to the donor site. Successful reconstruction with a two skin-island method was performed in both patients. Furthermore, donor site morbidity was minimal in both patients. When a DIEP free flap is used for head and neck reconstruction, elimination of dead space is the most difficult problem, because a DIEP free flap does not contain well-vascularized muscle tissue. We compensate for this disadvantage with a flap designed to include a de-epithelialized skin flap. Although this technique is not always the first choice for head and neck reconstruction, it is suitable for patients who wish to avoid donor site morbidity.
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Arterias Epigástricas/trasplante , Neoplasias de Cabeza y Cuello/cirugía , Microcirugia/métodos , Procedimientos de Cirugía Plástica/métodos , Trasplante de Piel/métodos , Colgajos Quirúrgicos/irrigación sanguínea , Pared Abdominal/irrigación sanguínea , Pared Abdominal/cirugía , Adulto , Procedimientos Quirúrgicos Dermatologicos , Femenino , Neoplasias de Cabeza y Cuello/patología , Humanos , Mucosa Bucal/patología , Mucosa Bucal/cirugía , Piel/irrigación sanguínea , Lengua/patología , Lengua/cirugíaRESUMEN
Next to their essential roles in plant growth and development, phytohormones play a central role in plant immunity against pathogens. In this study we studied the previously reported antagonism between the plant-pathogenic oomycete Pythium arrhenomanes and the root-knot nematode Meloidogyne graminicola, two root pathogens that co-occur in aerobic rice fields. In this manuscript, we investigated if the antagonism is related to imbalances in plant hormone levels, which could be involved in activation of plant defense. Hormone measurements and gene expression analyses showed that the jasmonate (JA) pathway is induced early upon P. arrhenomanes infection. Exogenous application of methyl-jasmonate (MeJA) on the plant confirmed that JA is needed for basal defense against both P. arrhenomanes and M. graminicola in rice. Whereas M. graminicola suppresses root JA levels to increase host susceptibility, Pythium inoculation boosts JA in a manner that prohibits JA repression by the nematode in double-inoculated plants. Exogenous MeJA supply phenocopied the defense-inducing capacity of Pythium against the root-knot nematode, whereas the antagonism was weakened in JA-insensitive mutants. Transcriptome analysis confirmed upregulation of JA biosynthesis and signaling genes upon P. arrhenomanes infection, and additionally revealed induction of genes involved in biosynthesis of diterpenoid phytoalexins, consistent with strong activation of the gene encoding the JA-inducible transcriptional regulator DITERPENOID PHYTOALEXIN FACTOR. Altogether, the here-reported data indicate an important role for JA-induced defense mechanisms in this antagonistic interaction. Next to that, our results provide evidence for induced expression of genes encoding ERF83, and related PR proteins, as well as auxin depletion in P. arrhenomanes infected rice roots, which potentially further contribute to the reduced nematode susceptibility seen in double-infected plants.
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TNF plus protein synthesis inhibitor cycloheximide-induced apoptosis in human myelogenous leukemia ML-1a but not in C19, respiration minus mitochondrial DNA-deficient C19 cells, derived from ML-1a. To investigate how mitochondrial DNA depletion inhibits apoptosis, we investigated AKT. Both AKT and its phosphorylated form were observed only in C19, indicating that depletion of mtDNA increased protein and the active form of AKT. Treatment of C19 with LY294002, which inhibits PI-3 kinase and inhibits AKT, significantly increased apoptosis induction by TNF plus cycloheximide and eliminated phosphorylation of AKT. These results indicate that AKT activation was induced by the depletion of mtDNA and inhibited TNF-induced apoptosis.
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Apoptosis/efectos de los fármacos , ADN Mitocondrial/fisiología , Leucemia Mieloide/metabolismo , Proteínas Proto-Oncogénicas c-akt/metabolismo , Factor de Necrosis Tumoral alfa/farmacología , Línea Celular Tumoral , Cromonas/farmacología , Células Clonales , Cicloheximida/farmacología , Humanos , Leucemia Mieloide/genética , Morfolinas/farmacología , Inhibidores de las Quinasa Fosfoinosítidos-3 , Fosforilación , Transducción de SeñalRESUMEN
The temperature elevations in anatomically based human phantoms of an adult and a 3-year-old child were calculated for radio-frequency whole-body exposure. Thermoregulation in children, however, has not yet been clarified. In the present study, we developed a computational thermal model of a child that is reasonable for simulating body-core temperature elevation. Comparison of measured and simulated temperatures revealed thermoregulation in children to be similar to that of adults. Based on this finding, we calculated the body-core temperature elevation in a 3-year-old child and an adult for plane-wave exposure at the basic restriction in the international guidelines. The body-core temperature elevation in the 3-year-old child phantom was 0.03 degrees C at a whole-body-averaged specific absorption rate of 0.08 W kg(-1), which was 35% smaller than in the adult female. This difference is attributed to the child's higher body surface area-to-mass ratio.
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Temperatura Corporal/fisiología , Temperatura Corporal/efectos de la radiación , Modelos Biológicos , Irradiación Corporal Total/métodos , Adulto , Preescolar , Simulación por Computador , Relación Dosis-Respuesta en la Radiación , Humanos , Dosis de Radiación , Ondas de RadioRESUMEN
OBJECTIVE: Larynx-preserving surgery is frequently performed for advanced hypopharyngeal cancer involving the larynx. However, reconstruction after partial pharyngolaryngectomy (PPL) remains a challenging problem because of the high risk of postoperative aspiration. In this report, we describe our new three-dimensional method for reconstructing supraglottic structures with a radial forearm flap. This is a retrospective analysis of 20 patients who underwent PPL for having hypopharyngeal cancer involving the larynx at our institution from 1996 to 2005. METHODS: The resulting pharyngolaryngeal defects were reconstructed with radial forearm flaps in all patients. Three-dimensional structures were reconstructed with a single nylon suture, which was used to hoist the flap and ensures that the arytenoids and the aryepiglottic fold were of appropriate height. RESULTS: Radial forearm flaps were transferred successfully in all but one case. Swallowing function was satisfactory in all patients, and decannulation could be performed in all but one patient. Postoperative conversational function in all patients was rated as excellent with Hirose's scoring system. CONCLUSIONS: Free jejunum transfer is the method of first choice for reconstruction of a defect after partial hypopharyngectomy. However, the complex supraglottic structures of the larynx are difficult to reconstruct with a free jejunal graft after PPL. In such cases, we perform three-dimensional reconstruction of the pharyngolaryngeal defect with a radial forearm flap and have achieved satisfactory postoperative function. We believe that our new procedure is a useful method for functional reconstruction after PPL.
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Antebrazo , Neoplasias Hipofaríngeas/fisiopatología , Neoplasias Hipofaríngeas/cirugía , Laringectomía , Laringe/cirugía , Faringectomía , Faringe/cirugía , Procedimientos de Cirugía Plástica/métodos , Colgajos Quirúrgicos , Adulto , Anciano , Cartílago Aritenoides/cirugía , Deglución , Epiglotis/cirugía , Femenino , Humanos , Neoplasias Hipofaríngeas/patología , Laringectomía/métodos , Metástasis Linfática , Masculino , Persona de Mediana Edad , Disección del Cuello , Estadificación de Neoplasias , Faringectomía/métodos , Procedimientos de Cirugía Plástica/efectos adversos , Aspiración Respiratoria/etiología , Aspiración Respiratoria/prevención & control , Estudios Retrospectivos , HablaRESUMEN
BACKGROUND/AIMS: Few case reports have previously documented a second surgery after pancreaticoduodenectomy due to recurrence or other reasons in patients with periampullary malignancies. The present report summarized the experience of this clinic with secondary surgery after Pancreaticoduodenectomy (PD). METHODOLOGY: During the past 7 years, 7 out of 95 patients with periampullary malignancies underwent a second surgery after pancreaticoduodenectomy at this institution. The clinical courses of these patients are presented and 2 interesting cases are shown in the present study. RESULTS: One patient with lower bile duct adenocarcinoma underwent a remnant splenopancreatectomy due to pancreatic recurrence 36 months after pancreaticoduodenectomy. The other patient with lower bile duct adenocarcinoma underwent a hepatectomy due to a solitary liver metastasis 47 months after a pancreaticoduodenectomy. These 2 patients have survived 4 and 13 months after the second surgery. In the 7 patients requiring secondary surgery, 5 underwent the procedure due to recurrent disease, and 4 of the 5 received the second surgery to remove the lesion. The mean interval between pancreaticoduodenectomy and the second operation was 32 months in the 5 patients with recurrent disease and 27 months in the all 7 patients. One of the 5 patients died of recurrent disease only 5 months after the second procedure because the surgery was a palliative bypass. However, the other 3 survived more than 1 year after the resection of the lesion at the recurrent site. CONCLUSIONS: The present study reports 2 rare cases with lower bile duct adenocarcinoma in which a recurrent tumor was removed after pancreaticoduodenectomy. In this study, 4 patients undergoing a curative re-operation survived more than 1 year after the surgery. The present study was small, but the findings are significant because of the scarcity of reports of patients undergoing secondary surgery after PD.
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Ampolla Hepatopancreática , Neoplasias del Conducto Colédoco/cirugía , Recurrencia Local de Neoplasia/cirugía , Pancreaticoduodenectomía , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , ReoperaciónRESUMEN
BACKGROUND/AIMS: Postoperative morbidity after a pancreaticoduodenectomy remains high mainly due to pancreatic fistula, but effective methods to prevent the development of pancreatic fistula have yet to be established. The present study prospectively investigated whether postoperative prophylactic irrigation around the pancreaticojejunostomy might be able to prevent eventual pancreatic fistula and infectious complications after a pancreaticoduodenectomy. METHOD: Among 75 patients undergoing a pancreaticoduodenectomy between 2003 and 2005, 50 patients in whom the drain amylase level on postoperative day 1 were 1,500 IU/L or more were selected for the present study. Twenty-six of the 50 patients underwent postoperative prophylactic 72-hour continuous irrigation around the pancreaticojejunostomy starting from postoperative day 1 (Irrigation group). On the other hand, 24 of them did not undergo such irrigation (Non-irrigation group). The incidence of pancreatic fistula, infectious complications, delayed gastric emptying, and the length of hospital stay were then compared between the 2 groups. RESULTS: The incidences of pancreatic fistula, wound infection, drain infection, sepsis, delayed gastric emptying, overall morbidity, and length of hospital stay were found to be significantly less in the irrigation group than in the non-irrigation group. CONCLUSIONS: Prophylactic irrigation may possibly be able to prevent the occurrence of pancreatic fistula and infectious complications after a pancreaticoduodenectomy in patients with a risky pancreatic remnant.
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Fístula Pancreática/etiología , Fístula Pancreática/prevención & control , Pancreaticoduodenectomía/efectos adversos , Pancreatoyeyunostomía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Cuidados Posoperatorios , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/prevención & control , Estudios Prospectivos , Factores de Riesgo , Irrigación TerapéuticaRESUMEN
AIM: One of the pitfalls in managing multiple liver tumors is the difficulty in identifying individual tumors on ultrasonography. Computed tomography (CT)-assisted virtual sonography has been shown to improve sonographic diagnosis, however it requires additional equipment and software. We have developed a simple reconstruction method of virtual sonography (SRVS). METHODS: We reconstructed SRVS mimicking ultrasonographic images, utilizing a workstation software attached to a multi-detector row CT system without any additional program. RESULTS: We have performed SRVS in 32 patients with 41 liver tumors that could hardly be identify on ultrasonography. SRVS assisted the identification of malignant form non-pathologic ones and thereby contributed to the appropriate clinical strategy including RFA (18 tumors), liver biopsy (2 tumors), other therapies (4 tumors) and follow-up (17 tumors). CONCLUSION: We have developed virtual sonography using conventional CT software. SRVS seems useful in the clinical practice in managing liver tumors.
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Neoplasias Hepáticas/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Ultrasonografía/métodos , Interfaz Usuario-Computador , HumanosRESUMEN
We report on the superconductor-insulator transitions (SITs) of disordered molybdenum nitride (MoN) thin films on (1 0 0) MgO substrates as a function of the film thickness and magnetic fields. The T c of the superconducting MoN films, which exhibit a sharp superconducting transition, monotonically decreases as the normal state R sq increases with a decreasing film thickness. For several films with different thicknesses, we estimate the critical field H c and the product zν ≃ 0.6 of the dynamical exponent z and the correlation length exponent ν using a finite scaling analysis. The value of this product can be explained by the (2 + 1) XY model. We found that the Hall resistance ΔR xy (H) is maximized when the magnetic field satisfies H HP(T) [Formula: see text] |1 - T/T C0| in the superconducting state and also in the normal states owning to the superconducting fluctuation corresponding to the ghost critical magnetic field. We measured the Hall conductivity δσ xy (H) = σ xy (H) - [Formula: see text] and fit the Gaussian approximation theory for δσ xy (H) to the experimental data. Agreement between the data and the theory beyond H c suggests the survival of the Cooper pair in the insulating region of the SIT.
RESUMEN
This study investigated the relationship between the specific absorption rate and temperature elevation in an anatomically-based model named NORMAN for exposure to radio-frequency far fields in the ICNIRP guidelines (1998 Health Phys. 74 494-522). The finite-difference time-domain method is used for analyzing the electromagnetic absorption and temperature elevation in NORMAN. In order to consider the variability of human thermoregulation, parameters for sweating are derived and incorporated into a conventional sweating formula. First, we investigated the effect of blood temperature variation modeling on body-core temperature. The computational results show that the modeling of blood temperature variation was the dominant factor influencing the body-core temperature. This is because the temperature in the inner tissues is elevated via the circulation of blood whose temperature was elevated due to EM absorption. Even at different frequencies, the body-core temperature elevation at an identical whole-body average specific absorption rate (SAR) was almost the same, suggesting the effectiveness of the whole-body average SAR as a measure in the ICNIRP guidelines. Next, we discussed the effect of sweating on the temperature elevation and thermal time constant of blood. The variability of temperature elevation caused by the sweating rate was found to be 30%. The blood temperature elevation at the basic restriction in the ICNIRP guidelines of 0.4 W kg(-1) is 0.25 degrees C even for a low sweating rate. The thermal time constant of blood temperature elevation was 23 min and 52 min for a man with a lower and a higher sweating rate, respectively, which is longer than the average time of the SAR in the ICNIRP guidelines. Thus, the whole-body average SAR required for blood temperature elevation of 1 degrees C was 4.5 W kg(-1) in the model of a human with the lower sweating coefficients for 60 min exposure. From a comparison of this value with the basic restriction in the ICNIRP guidelines of 0.4 W kg(-1), the safety factor was 11.