Monitoring ctDNA RAS Mutational Status in Metastatic Colorectal Cancer: A Trial Protocol of RAS-trace and RAS-trace-2 Studies.

Background: Spatial and temporal heterogeneities of RAS and other molecular genes should be considered in the treatment of metastatic colorectal cancer (mCRC) treated with anti-epidermal growth factor receptor (EGFR) monoclonal antibodies (mAbs); acquired RAS mutation is sometimes observed at disease progression of treatment with the anti-EGFR mAb. At the same time, discrepancy of RAS status from tissues and circulating tumor DNA (ctDNA) in the same patient is sometimes observed. Based on this, we commenced two observational studies to clarify these heterogeneities of RAS and BRAF in mCRC, using next generation sequencing from liquid biopsy. Methods/Design: RAS-trace study is an observational study to monitor ctDNA RAS/BRAF/PIK3CA status every 4-12 weeks using the Plasma-SeqSensei™ CRC RUO Kit (Sysmex Inostics GmbH) in mCRC with RAS/BRAF wild-type (wt) on tumor tissue. The primary endpoint was the time to the acquired RAS mutations. A total of 42 patients has been accrued. RAS-trace-2 study is also an observational study aimed at comparing the efficacy of the anti-EGFR mAb in ctDNA RAS/BRAF wt with ctDNA RAS or BRAF mutant mCRC patients, whose RAS/BRAF are wt in tumor tissue. The primary endpoint was progression-free survival in patients with ctDNA RAS/BRAF wt and RAS or BRAF mutant. A total of 240 patients will be accrued over 2 years. Discussion: These trials will help us understanding the clinical significance of spatial and temporal heterogeneities of RAS, BRAF and other genes, while optimizing the anti-EGFR mAb treatment strategies in mCRC.

Subcutaneous emphysema associated with laparoscopic or robotic abdominal surgery: a retrospective single-center study.

BACKGROUND: Subcutaneous emphysema (SCE) is a common complication in laparoscopic surgery. However, its precise incidence and impact on the clinical course are partially known. In this study, the incidence and risk factors of SCE were retrospectively analyzed. METHODS: Patients who underwent laparoscopic/robotic abdominal surgery (e.g., gastrointestinal, hepatobiliary, gynecologic, and urologic surgery) between October 2019 and September 2022 were retrospectively analyzed. The presence of SCE was confirmed by either conclusive findings obtained through chest/abdominal X-ray examination immediately after operation, or intraoperative palpation conducted by nurses. X-ray examination was performed in the operation room before extubation. RESULTS: A total of 2503 patients treated with laparoscopic/robotic abdominal surgery between October 2019 and September 2022 were identified and all of them were included in the analysis. SCE was confirmed in 23.1% of the patients (i.e., 577/2503). SCE was identified by X-ray examination in 97.6% of the patients. Extubation failure was observed in 10 patients; however, pneumothorax was not observed. Female sex (odds ratio [OR]: 2.09; 95% confidence interval [95%CI]: 1.69-2.57), age ≥ 80 years (OR 1.63; 95%CI 1.19-2.22), body mass index < 20 (OR 1.32; 95%CI 1.06-1.65), operation time > 360 min (OR 1.97; 95%CI 1.53-2.54), robotic surgery (OR 2.54; 95%CI 1.91-3.38), maximum intraabdominal pressure with CO2 > 15 mmHg (OR 1.79; 95%CI 1.02-3.16), and endo-tidal CO2 > 50 mmHg (OR 1.32; 95%CI 1.08-1.62)were identified as independent factors of SCE. Regarding the extubation failure due to SCE, age (OR 5.84; 95%CI 1.27-26.8) and maximum intraabdominal pressure with CO2 (OR 21.7; 95%CI 4.76-99.3) were identified as risk factors. CONCLUSION: Although the presence of SCE is associated with a low risk of severe complications, monitoring of the perioperative intraabdominal pressure is essential for performing safe laparoscopic/robotic surgery, particularly in elderly patients.

Anatomical Validation of Internal Iliac Vessels Assessed by Three-dimensional Angiographic Analysis.

Objectives: Anatomical understanding of the internal iliac vessels is important with the increasing frequency of minimally-invasive pelvic surgery. We aimed to investigate the branch patterns of internal iliac vessels, especially the veins. Methods: This study included 30 patients with 60 half-pelvises who underwent minimally-invasive pelvic surgery. Branch patterns were assessed on surgical videos with a multi-detector computed tomography-based three-dimensional simulation. Branch patterns of the superior gluteal artery and vein (SGA and SGV), inferior gluteal artery and vein (IGA and IGV), internal pudendal artery and vein (IPA and IPV), and obturator artery and vein (ObA and ObV) were investigated. Results: In the most frequent internal iliac vein (IIV) branch pattern, 67% of SGV branched from the IIV, 95% of the IGV branched from the IPV and 82% of the ObV branched from the IPV. According to Adachi's classification, 62% of IIVs were Type I and 33% Type IV. Although IIV branch patterns are heterogeneous, in individual patients with the most frequent branch patterns, good correlation (75-100%) of the branch patterns was observed between the internal iliac artery (IIA) and IIV, and between the right and left IIVs. Conclusions: This study clarified the branch patterns of IIV. In patients with the most frequent branch patterns, good correlation of the branch patterns was observed between the IIA and IIV, and between right and left IIV. We believe this helps secure the safety and standardization of minimally-invasive pelvic surgery.

Correlation between recurrence-free survival and overall survival after upfront surgery for resected colorectal liver metastases.

BACKGROUND: The role of recurrence-free survival (RFS) as a valid surrogate endpoint for overall survival (OS) in patients who underwent upfront surgery for colorectal liver metastases remains uncertain. The aim of the study was to compare the two survival measures in a nationwide cohort of upfront resected colorectal liver metastasis. METHODS: Data from patients with colorectal liver metastases without extrahepatic metastases who underwent curative surgery for liver metastases were retrieved from the Japanese nationwide database (data collection 2005-2007 and 2013-2014). RFS, OS, and survival after recurrence were estimated using the Kaplan-Meier method. The correlation (ρ) between RFS and OS was assessed using the rank correlation method combined with iterative multiple imputation, to account for censoring. As a secondary analysis, the correlation was evaluated according to adjuvant chemotherapy regimen. In sensitivity analysis, the pairwise correlation between RFS and OS was calculated. RESULTS: A total of 2385 patients with colorectal liver metastases were included. In the primary analysis, there was a moderately strong correlation between RFS and OS (ρ = 0.73, 95 per cent c.i. 0.70 to 0.76). The strength of the correlation was similar regardless of the adjuvant treatment regimen (oxaliplatin plus 5-fluorouracil: ρ = 0.72, 0.67 to 0.77; 5-fluorouracil alone: ρ = 0.72, 0.66 to 0.76; observation: ρ = 0.74, 0.69 to 0.78). The mean(s.d.) pairwise correlation coefficient between 3-year RFS and 5-year OS was 0.87(0.06). CONCLUSION: In surgically treated patients with colorectal liver metastases, there was a moderately strong correlation between RFS and OS, which was unaffected by the treatment regimen. Further validation using a trial-level analysis is required.

A peptide binding to the tetraspanin CD9 reduces cancer metastasis.

As an organizer of multi-molecular membrane complexes, the tetraspanin CD9 has been implicated in a number of biological processes, including cancer metastasis, and is a candidate therapeutic target. Here, we evaluated the suppressive effects of an eight-mer CD9-binding peptide (CD9-BP) on cancer cell metastasis and its mechanisms of action. CD9-BP impaired CD9-related functions by adversely affecting the formation of tetraspanin webs-networks composed of CD9 and its partner proteins. The anti-cancer metastasis effect of CD9-BP was evidenced by the in vitro inhibition of cancer cell migration and invasion as well as exosome secretion and uptake, which are essential processes during metastasis. Finally, using a mouse model, we showed that CD9-BP reduced lung metastasis in vivo. These findings provide insight into the mechanism by which CD9-BP inhibits CD9-dependent functions and highlight its potential application as an alternative therapeutic nano-biomaterial for metastatic cancers.

Superlattice-Induced Variations in Morphological and Emission Properties of GaInN/GaN Multiquantum Nanowire-Based Micro-LEDs.

Core-shell GaInN/GaN multiquantum shell (MQS) nanowires (NWs) are gaining great attention for high-efficiency micro-light-emitting diodes (micro-LEDs) owing to the minimized etching region on their sidewall, nonpolar or semipolar emission planes, and ultralow density of dislocations. In this study, we evaluated the changes in NW morphologies and the corresponding device properties induced by GaInN/GaN superlattice (SL) structures. The cathodoluminescence intensities of the samples with 20 and 40 pairs of SLs were about 2.2 and 3.4 times higher, respectively, than that of the sample without SLs. The high-resolution scanning transmission electron microscopy (STEM) inspection confirmed that the high growth temperature of SLs prevented growth in the semipolar plane region close to the n-GaN core. A similar phenomenon was also observed for the GaN quantum barriers of the semipolar MQS region under a high growth temperature of 810 °C. This phenomenon was ascribed to the passivation of the semipolar plane surface by hydrogen atoms and the high probability of decomposition through NH3 or N-H-related bonds. Although no clear SL grew on the semipolar plane near the n-core region, the top area of the nonpolar plane SL was expected to adequately suppress the point defects propagating from the n-GaN core to the semipolar plane MQS. The electroluminescence (EL) spectra and light output curves demonstrated a clear enhancement of more than 3-folds compared to the fabricated micro-LEDs without SL structures, which was associated with the improved crystalline quality of the MQS and enlarged area of the semipolar planes. Moreover, by increasing the growth time of GaN quantum barriers, the EL emission intensity of the micro-LED devices exhibited a 4-fold improvement owing to the reduced carrier overflow in the thickened GaN barriers on the semipolar (11̅01) planes. Thus, the results verified the possibility of realizing highly efficient NW-based micro-LEDs by optimizing the NW morphology using SL structures.

A Case Report of Primary Unresectable Hilar Cholangiocarcinoma Causing Colonic Obstruction Due to Peritoneal Dissemination.

Although surgical resection is the only available treatment to achieve long-term survival in biliary tract cancer, many cases are often identified at an advanced stage at the time of diagnosis. Radiotherapy may be an alternative option to prolong survival in cases with locally advanced unresectable disease. While there are some reports of long-term survival after radiotherapy for unresectable biliary tract cancer, it is rare that clinical symptoms are exhibited by peritoneal dissemination more than 8 years after radiotherapy and that resection can be performed. Our case was a 55-year-old female who had visited with a complaint of jaundice and was diagnosed with primary unresectable hilar cholangiocarcinoma. She received definitve chemoradiotherapy, and repeated receiving maintenance chemotherapy thereafter until clinical manifestation. During follow-up, she was diagnosed with stenosis of the sigmoid colon, which was attributed to peritoneal dissemination of cholangiocarcinoma. We herein report a rare case of primary unresectable hilar cholangiocarcinoma after chemoradiotherapy which was followed by chemotherapy that was controlled for more than 8 years but eventually caused colonic obstruction attributed to peritoneal dissemination.

[A Case of Ascending Colon Cancer with Skull Metastasis].

A 55-year-old woman became aware of a tumor on the left side of the head in July, 2020 and was referred to our hospital in September because of its rapid growth. A head CT showed a neoplastic lesion of the skull. A CT from the neck to the pelvis revealed an ascending colon tumor and multiple lesions in the liver, which was suspected as metastasis. A colonoscopy also showed a type 2 like lesion in the ascending colon, and a biopsy showed adenocarcinoma. A pedunculated polyp had been pointed out in the ascending colon at another hospital four years previously, and the pathological result was an adenoma, but endoscopic mucosal resection was not performed. It is considered that the adenoma became advanced colon cancer with metastasis through the mechanism of multistage carcinogenesis. Metastatic lesions of the ascending colon cancer was suspected with regard to the skull lesion. In addition to the rapid growth, surgical removal was desirable from the viewpoint of cosmetology, and surgery was performed in November. The postoperative pathological diagnosis was a metastatic skull tumor derived from ascending colon cancer. The diagnosis was Stage IVb according to the Japanese Classification of Colorectal, Appendiceal, and Anal Carcinoma (9th Edition). Although chemotherapy was started after surgery, the metastatic liver cancer increased rapidly and the patient passed away in April, 2021.

Morphology Control and Crystalline Quality of p-Type GaN Shells Grown on Coaxial GaInN/GaN Multiple Quantum Shell Nanowires.

The morphology and crystalline quality of p-GaN shells on coaxial GaInN/GaN multiple quantum shell (MQS) nanowires (NWs) were investigated using metal-organic chemical vapor deposition. By varying the trimethylgallium (TMG) flow rate, Mg doping, and growth temperature, it was verified that the TMG supply and growth temperature were the dominant parameters in the control of the p-GaN shape on NWs. Specifically, a sufficiently high TMG supply enabled the formation of a pyramid-shaped NW structure with a uniform p-GaN shell. The ratio of the growth rate between the c- and m-planes on the NWs was calculated to be approximately 0.4545. High-angle annular dark-field scanning transmission electron microscopy characterization confirmed that no clear extended defects were present in the n-GaN core and MQS/p-GaN shells on the sidewall. Regarding the p-GaN shell above the c-plane MQS region, only a few screw dislocations and Frank-type partial dislocations appeared at the interface between the serpentine c-plane MQS and the p-GaN shell near the tips. This suggested that the crystalline quality of the MQS structure can trigger the formation of screw dislocations and Frank-type partial dislocations during the p-GaN growth. The growth mechanism of the p-GaN shell on NWs was also discussed. To inspect the electronic properties, a prototype of a micro light-emitting diode (LED) with a chip size of 50 × 50 µm2 was demonstrated in the NWs with optimal growth. By correlating the light output curve with the electroluminescence spectra, three different emission peaks (450, 470, and 510 nm) were assignable to the emission from the m-, r-, and c-planes, respectively.

Crystal Growth and Characterization of n-GaN in a Multiple Quantum Shell Nanowire-Based Light Emitter with a Tunnel Junction.

Here, we systematically investigated the growth conditions of an n-GaN cap layer for nanowire-based light emitters with a tunnel junction. Selective-area growth of multiple quantum shell (MQS)/nanowire core-shell structures on a patterned n-GaN/sapphire substrate was performed by metal-organic vapor phase epitaxy, followed by the growth of a p-GaN, an n++/ p++-GaN tunnel junction, and an n-GaN cap layer. Specifically, two-step growth of the n-GaN cap layer was carried out under various growth conditions to determine the optimal conditions for a flat n-GaN cap layer. Scanning transmission electron microscopy characterization revealed that n++-GaN can be uniformly grown on the m-plane sidewall of MQS nanowires. A clear tunnel junction, involving 10-nm-thick p++-GaN and 3-nm-thick n++-GaN, was confirmed on the nonpolar m-planes of the nanowires. The Mg doping concentration and distribution profile of the p++-GaN shell were inspected using three-dimensional atom probe tomography. Afterward, the reconstructed isoconcentration mapping was applied to identify Mg-rich clusters. The density and average size of the Mg clusters were estimated to be approximately 4.3 × 1017 cm-3 and 5 nm, respectively. Excluding the Mg atoms contained in the clusters, the remaining Mg doping concentration in the p++-GaN region was calculated to be 1.1 × 1020 cm-3. Despite the lack of effective activation, a reasonably low operating voltage and distinct light emissions were preliminarily observed in MQS nanowire-based LEDs under the optimal n-GaN cap growth conditions. In the fabricated MQS-nanowire devices, carriers were injected into both the r-plane and m-plane of the nanowires without a clear quantum confinement Stark effect.

[A Resected Case of Adeno-Squamous Carcinoma of Gallbladder with Liver Invasions].

A patient was 70-year-old female. Because unknown fever following operation of left knee in December 20XX-1, abdominal simple CT was performed, diagnosed as cholecystitis and liver abscesses. However, her unknown fever did not improve with antibiotics therapy. Abdominal enhanced CT and MRI revealed to gallbladder cancer with liver invasion and metastases. These lesions were relatively localized in liver S4a/S5 and gallbladder, hepatoduodenal mesentery. Because unknown fever was exhausting, cholecystectomy, S4a+S5 hepatectomy with extrahepatic bile duct resection and lymph node dissemination were performed in January 20XX+1. In these pathological findings, there were moderate to poorly differentiated adenocarcinoma with squamous cell differentiation in almost area of gallbladder, diagnosed as adeno-squamous carcinoma with liver invasion and metastasis(pT3a[SI][H-inf], int, INF-ß, ly1, v3, pn1, pN1, pM1, pStage ⅣB). One months after operation, abdominal CT revealed multiple liver metastatic recurrences. She died 7 months after operation. Although gallbladder adeno-squamous carcinoma has a poor prognosis, these many cases had a tendency to local infiltration accompanied with tumor fever. If curative resection might be obtained and the symptoms might be improved, aggressive resection should be performed.

[A Case of Mesh Infection Due to Transverse Colon Cancer].

A 69-year-old female underwent a mesh repair for an abdominal incisional hernia 4 years previously in our hospital. She visited local hospital for abdominal pain and fever. Abdominal CT showed a localizes abscess formation above the mesh, then she was taken to our hospital. We suspected mesh infection and performed emergent mesh removal. After the operation, we examined for her anemia. Her colonoscopy and CT findings pointed to transverse colon cancer. We performed right hemicolectomy, and final diagnosis was transverse colon cancer pT4aN0M0, pStage Ⅱb. She underwent adjuvant chemotherapy, and 9 months after surgery, no recurrence was found.

Identification of multi-color emission from coaxial GaInN/GaN multiple-quantum-shell nanowire LEDs.

Multi-color emission from coaxial GaInN/GaN multiple-quantum-shell (MQS) nanowire-based light-emitting diodes (LEDs) was identified. In this study, MQS nanowire samples for LED processes were selectively grown on patterned commercial GaN/sapphire substrates using metal-organic chemical vapor deposition. Three electroluminescence (EL) emission peaks (440, 540, and 630 nm) were observed, which were primarily attributed to the nonpolar m-planes, semipolar r-planes, and the polar c-plane tips of nanowire arrays. A modified epitaxial growth sequence with improved crystalline quality for MQSs was used to effectively narrow the EL emission peaks. Specifically, nanowire-based LEDs manifested a clear redshift from 430 nm to 520 nm upon insertion of AlGaN spacers after the growth of each GaInN quantum well. This demonstrates the feasibility of lengthening the EL emission wavelength since an AlGaN spacer can suppress In decomposition of the GaInN quantum wells during ramping up the growth temperature for GaN barriers. EL spectra showed stable emission peaks as a function of the injection current, verifying the critical feature of the non-polarization of GaN/GaInN MQSs on nanowires. In addition, by comparing EL and photoluminescence spectra, the yellow-red emission linked to the In-fluctuation and point defects in the c-plane MQS was verified by varying the activation annealing time and lowering the growth temperature of the GaInN quantum wells. Therefore, optimization of MQS nanowire growth with a high quality of c-planes is considered critical for improving the luminous efficiency of nanowire-based micro-LEDs/white LEDs.

Correlation between Optical and Structural Characteristics in Coaxial GaInN/GaN Multiple Quantum Shell Nanowires with AlGaN Spacers.

High crystalline quality coaxial GaInN/GaN multiple quantum shells (MQSs) grown on dislocation-free nanowires are highly in demand for efficient white-/micro-light-emitting diodes (LEDs). Here, we propose an effective approach to improve the MQS quality during the selective growth by metal-organic chemical vapor deposition. By increasing the growth temperature of GaN barriers, the cathodoluminescent intensity yielded enhancements of 0.7 and 3.9 times in the samples with GaN and AlGaN spacers, respectively. Using an AlGaN spacer before increasing the barrier temperature, the decomposition of GaInN quantum wells was suppressed on all planes, resulting in a high internal quantum efficiency up to 69%. As revealed by scanning transmission electron microscopy (STEM) characterization, the high barrier growth temperature allowed to achieve a clear interface between GaInN quantum wells and GaN quantum barriers on the c-, r-, and m-planes of the nanowires. Moreover, the correlation between the In incorporation and structure features in MQS was quantitatively assessed based on the STEM energy-dispersive X-ray spectroscopy mapping and line-scan profiles of In and Al fractions. Ultimately, it was demonstrated that the unintentional In incorporation in GaN barriers was induced by the evaporation of predeposited In-rich particles during low-temperature growth of GaInN wells. Such residual In contamination was sufficiently inhibited by inserting low Al fraction (∼6%) AlGaN spacers after each GaInN well. During the growth of AlGaN spacers, AlN polycrystalline particles were deposited on the surrounding dummy substrate, which suppressed the evaporation of the predeposited In-rich particles. Thus, the presence of AlGaN spacers certainly improved the uniformity of In fraction through five GaInN quantum wells and reduced the diffusion of point defects from n-core to MQS active structures. The superior coaxial GaInN/GaN MQS structures with the AlGaN spacer are supposed to improve the emission efficiency in white-/micro-LEDs.

Development of Monolithically Grown Coaxial GaInN/GaN Multiple Quantum Shell Nanowires by MOCVD.

Broadened emission was demonstrated in coaxial GaInN/GaN multiple quantum shell (MQS) nanowires that were monolithically grown by metalorganic chemical vapor deposition. The non-polar GaInN/GaN structures were coaxially grown on n-core nanowires with combinations of three different diameters and pitches. To broaden the emission band in these three nanowire patterns, we varied the triethylgallium (TEG) flow rate and the growth temperature of the quantum barriers and wells, and investigated their effects on the In incorporation rate during MQS growth. At higher TEG flow rates, the growth rate of MQS and the In incorporation rate were promoted, resulting in slightly higher cathodoluminescence (CL) intensity. An enhancement up to 2-3 times of CL intensity was observed by escalating the growth temperature of the quantum barriers to 800 °C. Furthermore, decreasing the growth temperature of the quantum wells redshifted the peak wavelength without reducing the MQS quality. Under the modified growth sequence, monolithically grown nanowires with a broaden emission was achieved. Moreover, it verified that reducing the filling factor (pitch) can further promote the In incorporation probability on the nanowires. Compared with the conventional film-based quantum well LEDs, the demonstrated monolithic coaxial GaInN/GaN nanowires are promising candidates for phosphor-free white and micro light-emitting diodes (LEDs).

[A Case of Intestinal Obstruction Caused by Peritoneal Metastatic Recurrence One Year after Radical Operation for Pancreatic Cancer].

In December 20XX-1, abdominal enhanced CT of a 73-year-old female patient showed a 28mm-in-diameter pancreatic tail cancer with splenic venous invasion. She underwent neoadjuvant GEM/TS-1 combination chemotherapy but abandoned this chemotherapy due to melena and exanthema. She underwent a distal pancreatectomy with lymph node dissemination. In these pathological findings, the tumor was diagnosed as a pancreatic tail cancer with splenic venous invasion(T3, N0, M0, Stage ⅡA). She underwent adjuvant GEM chemotherapy, but she abandoned this chemotherapy due to exanthema and was managed with observation. In September 20XX, she had a postoperative bowel obstruction and was treated with natural light. However, she had a postoperative bowel obstruction again in July, 20XX+1. Fluoroscopic images revealed stenosis in the intestine located 170 cm from the nasal cavity. She underwent open surgery to manage the bowel obstruction. There was a peritoneal tumor with adhesion to each intestine serosa in 3 areas located 80 cm, 100 cm, and 150 cm from the Treitz ligament. Therefore, she underwent a small intestine resection and anastomosis 70 cm to 110 cm from the Treitz ligament. Pathological findings showed that there was a 3mm-in-diameter adenocarcinoma in this peritoneal tumor. In these findings, this final diagnosis was an adhesive intestinal obstruction caused by peritoneal metastasis. Curative resection for single peritoneal recurrent metastasis might be useful for prognosis prolongation.

Genetic and epigenetic aberrations of ABCB1 synergistically boost the acquisition of taxane resistance in esophageal squamous cancer cells.

Taxanes are applied as potent chemotherapeutic agents in the treatment of patients with esophageal cancer, but their usefulness is limited, partly because of acquisition of chemoresistance. In our previous study, we established three taxane resistant esophageal cancer cell lines; significant ABCB1 upregulations were found in all three. However, the responsible mechanism(s) still remains an open question. In this study, we explored possible mechanisms that might contribute to upregulation of ABCB1 in taxane resistant cells. ABCB1 gene amplification was found in taxane resistant cell line RTE-1P, but expressional upregulation cannot be explained only by gene amplification, because gene amplification is one order of magnitude or less whereas gene expression is more than two orders of magnitude. In the parental TE-1, ABCB1 expression was upregulated after treatment with 5-azadeoxycytidine and/or trichostatin A; epigenetic mechanisms may be deeply involved. ABCB1 has two promoters; a downstream promoter was found to play the dominant role in taxane resistant esophageal cancer cell lines. Analyses of CpG islands demonstrated that taxane resistant cells showed unmethylated CGI whereas parental cells were dominantly methylated. In conclusion, we propose that both the ABCB1 gene amplification and aberrations in epigenetic mechanisms are responsible for acquisition of taxane resistance in esophageal cancer cells.

[Bilateral Multiple Liver Metastases after Pancreatoduodenectomy for a Duodenal Neuroendocrine Tumor-A Case Report].

The patient was a 79-year-old woman. In January 20XX, upper gastrointestinal endoscopy revealed a duodenal tumor with bleeding and ulceration. This tumor was diagnosed as a duodenal neuroendocrine tumor(NET)based on biopsy findings. In March 20XX, the patient underwent pancreatoduodenectomy with lymph node dissemination. Based on these pathological findings, the tumor was diagnosed as a duodenal NET(G2)with a lymph node metastasis(T2, N1, M0, Stage Ⅲ). Twenty months after the operation, abdominal CT revealed multiple liver metastases(S4, S7, and S8). After this recurrence, she underwent the subcutaneous somatostatin analogue injection therapy every 28 days, and transarterial chemoembolization( TACE)when these recurrent tumors showed remarkable regrowth, once a year, accounting for her age. She has maintained good disease control for 5 years.