GRP78 Protein Expression as Prognostic Values in Neoadjuvant Chemoradiotherapy and Laparoscopic Surgery for Locally Advanced Rectal Cancer.

PURPOSE: We investigated the relationships between biomarkers related to endoplasmic reticulum stress proteins (glucose-regulated protein of molecular mass 78 [GRP78] and Cripto-1 [teratocarcinoma-derived growth factor 1 protein]), pathologic response, and prognosis in locally advanced rectal cancer. MATERIALS AND METHODS: All clinical stage II and III rectal cancer patients received 50.4 Gy over 5.5 weeks, plus 5-fluorouracil (400 mg/m(2)/day) and leucovorin (20 mg/m(2)/day) bolus on days 1 to 5 and 29 to 33, and surgery was performed at 7 to 10 weeks after completion of all therapies. Expression of GRP78 and Cripto-1 proteins was determined by immunohistochemistry and was assessed in 101 patients with rectal cancer treated with neoadjuvant chemoradiotherapy (CRT). RESULTS: High expression of GRP78 and Cripto-1 proteins was observed in 86 patients (85.1%) and 49 patients (48.5%), respectively. Low expression of GRP78 protein was associated with a significantly high rate of down staging (80.0% vs. 52.3%, respectively; p=0.046) and a significantly low rate of recurrence (0% vs. 33.7%, respectively; p=0.008) compared with high expression of GRP78 protein. Mean recurrence-free survival according to GRP78 expression could not be estimated because the low expression group did not develop recurrence events but showed a significant correlation with time to recurrence, based on the log rank method (p=0.007). GRP78 also showed correlation with overall survival, based on the log rank method (p=0.045). CONCLUSION: GRP78 expression is a predictive and prognostic factor for down staging, recurrence, and survival in rectal cancer patients treated with 5-fluorouracil and leucovorin neoadjuvant CRT.

A comparative study of DA-9601 and misoprostol for prevention of NSAID-associated gastroduodenal injury in patients undergoing chronic NSAID treatment.

Misoprostol is reported to prevent non-steroidal anti-inflammatory drug (NSAID)-associated gastroduodenal complications. There is, however, limited information regarding the efficacy of DA-9601 in this context. We performed a comparative study on the relative efficacy of DA-9601 and misoprostol for prevention of NSAID-associated complications. In this multicenter, double-blinded, active-controlled, stratified randomized, parallel group, non-inferiority trial, 520 patients who were to be treated with an NSAID (aceclofenac, 100 mg, twice daily) over a 4-week period were randomly assigned to groups for coincidental treatment with DA-9601 (60 mg, thrice daily) (236 patients for full analysis) or misoprostol (200 µg, thrice daily) (242 patients for full analysis). [corrected]. The primary endpoint was the gastric protection rate, and secondary endpoints were the duodenal protection rate and ulcer incidence rate. Endpoints were assessed by endoscopy after the 4-week treatment period. Drug-related adverse effects, including gastrointestinal (GI) symptoms, were also compared. At week 4, the gastric protection rates with DA-9601 and misoprostol were 81.4 % (192/236) and 89.3 % (216/242), respectively. The difference between the groups was -14.2 %, indicating non-inferiority of DA-9601 to misoprostol. Adverse event rates were not different between the two groups; however, the total scores for GI symptoms before and after administration were significantly lower in the DA-9601 group than in the misoprostol group (-0.2 ± 2.8 vs 1.2 ± 3.2; p < 0.0001). DA-9601 is as effective as misoprostol in preventing NSAID-associated gastroduodenal complications, and has a superior adverse GI effect profile.

Intractable rectal stricture caused by hot water enema.

Rectal burns caused by hot water enema have been reported only occasionally and the majority of them were treated in a conservative manner. Although intractable rectal stricture caused by rectal burn is rare, it may be treated by endoscopic intervention or surgery. A 52-year-old woman who had used various methods of enema to treat her chronic constipation eventually undertook a hot water enema herself. After that, anal pain and constipation became aggravated prompting her to visit our clinic. Although various nonoperative treatments including endoscopic stenting were performed, her obstructive symptom did not improve and endoscopic findings had not changed. Hence, we performed a laparoscopic proctosigmoidectomy and transanal coloanal anastomosis with ileal diversion to treat the disease, and as a result, her obstructive symptom improved well. Corrective surgery such as resection of involved segment with anastomosis may be beneficial in relieving obstructive symptoms of an intractable rectal stricture caused by hot water enema.

[Nutrition in inflammatory bowel disease].

Nutrition, as a definite environmental factor, has been implicated in the pathogenesis of inflammatory bowel disease (IBD). Although low-fiber, high-sugar, and high-animal fat diets have been proposed as a risk factor, the role of nutrition in IBD still needs more conclusive evidence. Nutritional deficiency is a common problem in IBD patients. The goals of nutritional intervention are the prevention and correction of malnutrition, the prevention of osteoporosis, and the promotion of optimal growth and development in childhood. Enteral nutrition is effective in induction and maintenance of the clinical remission in adults and promoting growth in children with Crohn's disease. The n-3 polyunsaturated fatty acids contained in fish oil may provide short-term benefit to patients with IBD.