Temporal changes in functional outcomes of stapled and hand-sewn ileal pouch-anal anastomosis for ulcerative colitis and familial adenomatous polyposis.

AIM: Little is known about how ileal pouch-anal anastomosis (IPAA) influences anorectal manometric data. This study aimed to clarify temporal changes in anorectal manometric data and faecal incontinence in IPAA. METHODS: We examined 32 patients with ulcerative colitis (UC) or familial adenomatous polyposis (FAP) undergoing restorative proctocolectomy with stapled or hand-sewn IPAA. Maximum resting pressure (MRP) and maximum squeezing pressure (MSP) were analysed before and 1-3, 6-9, and 12-24 months after IPAA. Cleveland Clinic Florida-Faecal Incontinence Score (CCF-FIS) was measured 6-9 and 12-24 months after IPAA. RESULTS: Fourteen patients underwent stapled IPAA and 18 patients underwent hand-sewn IPAA. MRP decreased 1-3 months after stapled IPAA (median: 42.3 mmHg vs. 60.0 mmHg at preoperative value, p = 0.039), but recovered afterwards. In hand-sewn IPAA, the median MRP decreased to 29.5 mmHg at 1-3 months after IPAA (baseline: 64.8 mmHg, p < 0.0001), and remained unchanged thereafter. Stapled IPAA did not affect MSP; however, hand-sewn IPAA caused a reduction in the median MSP from 191.3 mmHg to 141.3 mmHg at 1-3 months (p = 0.035), which gradually increased afterwards. The median CCFFIS was 5.5 points at 6-9 months and 2 points at 12-24 months after stapled IPAA. The score was high (11 points) at 6-9 months but decreased to 5 points at 12-24 months after hand-sewn IPAA (p = 0.022). CONCLUSION: We present time trends in functional outcomes of IPAA. MRP showed a transient decrease after stapled IPAA, whereas it remained low after hand-sewn IPAA. CCFFIS was high only at 6-9 months after hand-sewn IPAA.

Low preoperative maximum squeezing pressure evaluated by anorectal manometry is a risk factor for non-reversal of diverting stoma.

PURPOSE: A diverting stoma is created to prevent anastomotic leakage and related complications impairing sphincteric function in rectal surgery. However, diverting stoma may be left unclosed. This study is aimed to analyze preoperative factors including anorectal manometric data associated with diverting stoma non-reversal before rectal surgery. We also addressed complications related to diverting stoma in patients undergoing surgery for rectal malignant tumor. METHODS: A total of 203 patients with rectal malignant tumor who underwent sphincter-preserving surgery with diverting stoma were retrospectively evaluated. The risk factors for non-reversal of diverting stoma were identified by univariate and multivariate analyses. For these analyses, anorectal manometric data were measured before rectal surgery. The association between stoma-related complications and other clinicopathological features was also analyzed. RESULTS: During the median follow-up of 46.4 months, 24% (49 patients) did not undergo stoma reversal. Among parameters that were available before rectal surgery, age ≥ 75 years, albumin < 3.5 g/dl, tumor size ≥ 30 mm, tumor distance from the anal verge < 4 cm, and maximum squeezing pressure (MSP) < 130 mmHg measured by anorectal manometry (ARM) were independent factors associated with stoma non-reversal. The most common stoma-related complication was peristomal skin irritation (25%). Ileostomy was the only factor associated with peristomal skin irritation. CONCLUSION: The current study demonstrated that low preoperative MSP evaluated by ARM, old age, hypoalbuminemia, and a large tumor close to the anus were predictive of diverting stoma non-reversal. Stoma site should be well deliberated when patients have the aforementioned risk factors for diverting stoma non-reversal.

Quantitative proteomics of Arabidopsis shoot microsomal proteins reveals a cross-talk between excess zinc and iron deficiency.

Iron (Fe) deficiency significantly effects plant growth and development. Plant symptoms under excess zinc (Zn) resemble symptoms of Fe-deficient plants. To understand cross-talk between excess Zn and Fe deficiency, we investigated physiological parameters of Arabidopsis plants and applied iTRAQ-OFFGEL quantitative proteomic approach to examine protein expression changes in microsomal fraction from Arabidopsis shoots under those physiological conditions. Arabidopsis plants manifested shoot inhibition and chlorosis symptoms when grown on Fe-deficient media compared to basal MGRL solid medium. iTRAQ-OFFGEL approach identified 909 differentially expressed proteins common to all three biological replicates; the majority were transporters or proteins involved in photosynthesis, and ribosomal proteins. Interestingly, protein expression changes between excess Zn and Fe deficiency showed similar pattern. Further, the changes due to excess Zn were dramatically restored by the addition of Fe. To obtain biological insight into Zn and Fe cross-talk, we focused on transporters, where STP4 and STP13 sugar transporters were predominantly expressed and responsive to Fe-deficient conditions. Plants grown on Fe-deficient conditions showed significantly increased level of sugars. These results suggest that Fe deficiency might lead to the disruption of sugar synthesis and utilization.

[Paratracheal lymph node metastasis from papillary thyroid carcinoma presented as a middle mediastinal cyst;report of a case].

The majority of middle mediastinal cysts are benign diseases. However, some cases of middle mediastinal cysts are revealed to be malignant tumor. We herein report a case of a middle mediastinal cyst, which proved to be a right paratracheal lymph node metastasis from the thyroid papillary carcinoma. The patient was a 67-year-old lady who had underwent thyroidectomy and regional lymph node dissection for papillary thyroid carcinoma 6 years before. Follow-up computed tomography revealed a growing cyst at the right-side of the intrathoracic trachea. Metastasis from thyroid cancer was suspected from her history. The right upper mediastinal lymphadenectomy through thoracoscopy was performed. Pathologically, the cyst was diagnosed as a metastasis from thyroid cancer, showing cystic change.

Establishing a novel method for assessing elasticity of internal anal sphincter using ultrasonic real-time tissue elastography.

BACKGROUND: Evaluating anorectal function using real-time tissue elastography (RTE) has not been reported. A previous study reported that in the internal anal sphincter (IAS) of surgical specimens of patients with rectal cancer who underwent abdominoperineal resection, there was an increased fibrosis trend in those who underwent pre-operative chemoradiotherapy (CRT) compared with non-CRT. We speculated that CRT might have induced sclerosis of the IAS because of fibrosis. Therefore, we aimed to establish a method of quantitating the degree of IAS hardness using RTE on endoanal ultrasonography. METHODS: RTE was performed with freehand manual compression under a defined pressure at the middle anal canal. Using the most compressive point in the strain graph, we traced the region of interest in the IAS. The strain histogram showed a frequency distribution of colours according to the degree of strain (numeric scan ranging from 0 to 255; smaller number indicated harder tissue). We defined the mean of the strain histogram as 'elasticity'. Ten patients with locally advanced rectal cancer who underwent pre-operative CRT were prospectively enrolled. We statistically evaluated the correlation between IAS elasticity and maximum resting pressure (MRP) values both at pre- and post-CRT. MRP was examined concurrently with the examination of IAS elasticity. RESULTS: Representativity of elasticity measurements was demonstrated. It revealed a trend: IAS elasticity had a moderate inverse correlation with MRP (r = 0.41, P = 0.07), regardless of whether measurements were made before or after CRT. CONCLUSION: We established a completely novel method for the assessment of elasticity of the IAS, using RTE on endoanal ultrasonography.

Quantitative Proteomic Analysis of the Response to Zinc, Magnesium, and Calcium Deficiency in Specific Cell Types of Arabidopsis Roots.

The proteome profiles of specific cell types have recently been investigated using techniques such as fluorescence activated cell sorting and laser capture microdissection. However, quantitative proteomic analysis of specific cell types has not yet been performed. In this study, to investigate the response of the proteome to zinc, magnesium, and calcium deficiency in specific cell types of Arabidopsis thaliana roots, we performed isobaric tags for relative and absolute quantification (iTRAQ)-based quantitative proteomics using GFP-expressing protoplasts collected by fluorescence-activated cell sorting. Protoplasts were collected from the pGL2-GFPer and pMGP-GFPer marker lines for epidermis or inner cell lines (pericycle, endodermis, and cortex), respectively. To increase the number of proteins identified, iTRAQ-labeled peptides were separated into 24 fractions by OFFGFEL electrophoresis prior to high-performance liquid chromatography coupled with mass spectrometry analysis. Overall, 1039 and 737 proteins were identified and quantified in the epidermal and inner cell lines, respectively. Interestingly, the expression of many proteins was decreased in the epidermis by mineral deficiency, although a weaker effect was observed in inner cell lines such as the pericycle, endodermis, and cortex. Here, we report for the first time the quantitative proteomics of specific cell types in Arabidopsis roots.