Gradients of flow regulation shape community structures of stream fishes and insects within a catchment subject to typhoon events.

Alterations in natural flow regimes caused by dams can significantly alter the aquatic habitats of stream organisms. However, few studies have characterized flow regulation to assess its impacts on stream fauna in the context of interannually variable extreme floods. This study aims to understand the variation in stream animals along flow regulation gradients due to hydropower dams in a catchment experiencing typhoons. We observed freshwater fishes and stream insects at fully regulated sites (receiving residual flow), moderately regulated sites (receiving hydropower outflow), and nonregulated site (tributary) in the Mimi River catchment in southern Japan, in summer and winter from 2010 to 2018. We computed indicators of hydrologic alteration (IHA) in each calendar/water (July to June) year from 2007 to 2017 and selected subsets of IHA based on principal component analysis (PCA) and variance inflation factor. The largest variance was mainly explained by minimum discharge levels (e.g., 30-day annual minimum) and flow variability among IHAs, distinguishing the moderately regulated and nonregulated sites from fully regulated sites because of residual flow and suppressed high pulses in the fully regulated sites. Generalized additive models revealed that annual maxima of specific discharge were most significant predictors of fish and insect metrics while its effects were generally inconsistent between summer and winter. Non-metric multidimensional scaling revealed that insect communities were clustered into the regulation extents in both seasons. The differences in winter fauna between the regulated and nonregulated sites, characterized by Ephemeroptera-Plecoptera-Trichoptera abundance, were associated with maximum discharge and high pulse numbers. Fish community variation did not correspond to flow regime gradients. Our findings on mechanistic ecohydrological consequences of various flow regulations, supported by long-term observations, will be useful for river managers attempting to compensate for alterations in flow regime and ecological integrity.

A Multicenter Randomized Controlled Study of Paclitaxel plus Carboplatin versus Oral Uracil-Tegafur as the Adjuvant Chemotherapy in Resected Non-Small Cell Lung Cancer.

INTRODUCTION: We conducted a randomized controlled study to compare the survival benefit of paclitaxel plus carboplatin and oral uracil-tegafur (UFT) as adjuvant chemotherapy in resected NSCLC. METHODS: In an open-label multicenter trial, patients with pathological stage IB to IIIA NSCLC were randomized into a group receiving paclitaxel (175 mg/m2) plus carboplatin (area under the curve 5) every 3 weeks for four cycles (arm A) or a group receiving orally administered UFT (250 mg/m2) daily for 2 years (arm B). The primary and secondary end points were overall survival and relapse-free survival and toxicity, respectively. RESULTS: Between November 2004 and November 2010, 402 patients from 40 institutions were included (201 in each arm). The median follow-up period was 6.5 years. The 5-year overall survival rate was 70% (95% confidential interval [CI]: 63-76] in arm A versus 73% (95% CI: 66-78) in arm B (hazard ratio = 0.92, 95% CI: 0.55-1.41, p = 0.69). There was no significant difference in the 5-year relapse-free survival rate between arms A and B (56% versus 57% [hazard ratio = 0.92, 95% CI: 0.63-1.34, p = 0.50]). Toxicities were well tolerated and there was no treatment-related death. Toxicities of any grade or grade 4 were significantly more frequent in the paclitaxel plus carboplatin group (95.7% and 22.1%, respectively) than in the UFT group (76.5% and 1.0%, respectively [p < 0.0001 in both]). CONCLUSIONS: As adjuvant chemotherapy, paclitaxel plus carboplatin was no better than UFT in terms of survival among patients with stage IB to IIIA NSCLC tumors who underwent complete resection (UMIN000000810).

Gastric liposarcoma resected by laparoscopic total gastrectomy to achieve a wide surgical margin.

Gastric liposarcoma is an extremely rare tumour that usually affects the extremities and retroperitoneum. Preoperative diagnosis is difficult, and operative procedures are not well standardised. A 61-year-old woman presented with melaena, epigastric discomfort and palpitations. Upper endoscopy revealed a submucosal tumour at the posterior gastric fundus with an actively bleeding ulcer on the top. Our preoperative diagnosis was lipoma, and we performed laparoscopic intragastric surgery. However, the histopathological diagnosis was liposarcoma. Laparoscopic total gastrectomy was performed to achieve a wide surgical margin. Several recent series have shown that a positive microscopic margin is associated with a higher rate of local recurrence than a negative margin. We have added a staged operation to obtain a wide margin in cases involving a positive surgical margin. Preoperative diagnosis of liposarcoma is still challenging. Gastric lipoma-like tumours should be resected with a wide margin because of their possibility of malignancy.

Randomized feasibility study of S-1 for adjuvant chemotherapy in completely resected Stage IA non-small-cell lung cancer: results of the Setouchi Lung Cancer Group Study 0701.

OBJECTIVE: The aim of this multicenter study was to determine the appropriate administration schedule for S-1, an oral fluoropyrimidine, for adjuvant chemotherapy in patients with completely resected pathological-Stage IA (tumor diameter, 2-3 cm) non-small-cell lung cancer. METHODS: Patients were randomly assigned to receive adjuvant chemotherapy consisting of either the 4-week oral administration of S-1 (80-120 mg/body/day) followed by a 2-week rest (Group A), or the 2-week oral administration of S-1 (80-120 mg/body/day) followed by a 1-week rest (Group B). The duration of adjuvant chemotherapy was 1 year in both arms. The primary endpoint was compliance, namely drug discontinuation-free survival, which was calculated using the Kaplan-Meier method with log-rank test. RESULTS: Eighty patients were enrolled in this study, and 76 patients actually received S-1 treatment. The drug discontinuation-free survival rates at 1 year were 49.1% in Group A and 52.7% in Group B (P = 0.373). The means of the relative dose intensities were 55.3% in Group A and 64.6% in Group B (P = 0.237). There were no treatment-related deaths. Patients with grade 3/4 toxicities were significantly more frequent in Group A (40.5%) than in Group B (15.4%, P = 0.021). The 2-year relapse-free survival rates were 97.5% in Group A and 92.5% in Group B, and the 2-year overall survival rates were 100% in both groups. CONCLUSIONS: The feasibility showed no significant difference between the two groups among patients with completely resected Stage IA (tumor diameter, 2-3 cm) non-small-cell lung cancer.

Pathologic Assessment of Pancreatic Fibrosis for Objective Prediction of Pancreatic Fistula and Management of Prophylactic Drain Removal After Pancreaticoduodenectomy.

BACKGROUND: Soft pancreatic texture is a commonly accepted risk factor associated with pancreatic fistula (PF) after pancreaticoduodenectomy (PD). However, its evaluation is subjective and its predictive value is limited. The present study was performed to establish intraoperative PF prediction parameter: the pathological assessment of pancreatic fibrosis, which was an objective evaluation that was strongly related to pancreatic consistency. METHODS: Based on the results of a retrospective investigation on grades of pancreatic fibrosis and PF occurrence in 51 consecutive patients, an algorithm for intraoperative selection of early prophylactic drain removal was established. Prophylactic drains of patients with pancreatic fibrosis ≥ 30 % in the frozen section of pancreatic stump were removed on postoperative day (POD) 4. As CRP ≥ 10 mg/dL on POD 4 was a strong risk factor for PF in patients with fibrosis <30 %, the drains of these patients were maintained. RESULTS: The algorithm was applied to 26 consecutive patients. Prophylactic drains were removed in 14 patients and retained in 12 patients on POD 4. No PF was observed in patients with pancreatic fibrosis ≥ 30 % (n = 8). Among six patients with fibrosis <30 %, CRP <10 mg/dL, and without infection in the drain fluid, only two developed grade A PF. All nine patients with pancreatic fibrosis <30 % and CRP ≥ 10 mg/dL developed grade B PF. No grade C PF was observed in any group. CONCLUSIONS: The pathological evaluation of pancreatic fibrosis could objectively predict PF occurrence. Intraoperative assessment of pancreatic fibrosis could be applied to tailor postoperative drain management after PD.

[Calcified amorphous tumor of the right atrium after open heart surgery; report of a case].

A 37-year-old woman, who had undergone surgery of atrial septal defect (ASD) at 12-year-old, developed bradycardia and referred to our hospital. Transthoracic echocardiography revealed high echoic tumor in the right atrium. The image of the tumor was of low intensity by T2 weighted magnetic resonance imaging (MRI) and floating mass with a stalk to the right atrium in cine MRI. She underwent tumor resection under cardiopulmonary bypass. Histopathologilal examination of the tumor was calcified amorphous tumor. The postoperative course was uneventful.

Ciliated hepatic foregut cyst with obstructive jaundice.

Ciliated hepatic foregut cysts (CHFCs) are rare congenital cystic lesion that are most often solitary, unilocular, and located in the subcapsular region of the medial segment of the left hepatic lobe. The mucoid fluid contents affect imaging studies and often make definitive diagnosis difficult. CHFCs are usually asymptomatic and found incidentally. We report a 69-year-old female patient with a CHFC causing obstructive jaundice, which was difficult to differentiate from a biliary cystic neoplasm. A well-defined cystic lesion measuring 25 mm in diameter was located in the porta hepatis region. The lesion was densely adherent to the left and right hepatic ducts, riding on the bifurcation, and the common hepatic duct was extrinsically compressed. An extended left hepatectomy was performed. A diagnosis of CHFC was made on the basis of typical histological findings. CHFC should be included in the differential diagnosis for cystic lesions of the liver.

Synchronous bilateral noninvasive ductal carcinoma of the male breast: a case report.

A 45-year-old man developed a bloody discharge from his right nipple. Physical examination revealed bloody discharge from his left nipple also but no swelling, breast mass, or axillary lymph nodes. He then underwent bilateral total glandectomy without axillary dissection. Histological examination revealed low-grade ductal carcinoma in situ (DCIS) with a low-papillary and cribriform pattern measuring about 4 mm in diameter in the breast bilaterally. To our knowledge, this is the first report of synchronous bilateral DCIS in a male. Since this patient's hormonal profile showed a relatively high blood level of prolactin, the causative relationship between hyperprolactinemia and male breast cancer is discussed. Including our case, 5 of 6 cases reported thus far have been bilateral, and 4 of the 6 cases have been synchronous. We emphasize that the contralateral breast should also be tested or followed in male breast cancer patients with hyperprolactinemia.

Off-pump coronary artery bypass grafting in two renal transplant patients.

Coronary artery disease is a critical problem for a renal transplant patient. This paper reports off-pump coronary artery bypass grafting (OPCABG) in two cases after renal transplantation. The first, a 65-year-old woman, experienced chest pain 5 years after a renal transplantation. Coronary angiography (CAG) revealed stenosis of the left anterior descending artery (LAD) and the first diagonal artery (DB1). OPCABG [left internal thoracic artery (LITA) to DB1 and LAD] was performed. The second, a 67-year-old man, underwent percutaneous coronary intervention in the LAD 10 years ago. He experienced chest pain 2 years after a renal transplantation. CAG revealed restenosis of LAD. OPCABG (LITA to LAD) was performed. The patients' postoperative course was uneventful. OPCABG for a renal transplant patient was safe and useful since it is a less invasive procedure and easily managed perioperatively.

Simultaneous off-pump coronary artery bypass grafting and in vivo heterogenous renal transplantation. Considering results and indications.

Complications of arterial sclerosis lesions are found in patients in dialysis for end-stage chronic renal failure. We present a case of simultaneous coronary artery bypass grafting (CABG) and renal transplantation. A 64-year-old man was to undergo in vivo heterogenous renal transplantation for chronic renal failure. Angiography was undertaken for preoperative abnormal electrocardiography, which showed severe long segmental stenosis of the left anterior descending coronary artery. We discussed the possibility of simultaneous surgery, conducting off-pump CABG and renal transplantation at the same time. Postoperative management of the implanted kidney was easy despite high infusion. His postoperative course went well, without cardiac events. Simultaneous off-pump CABG and in vivo heterogenous thus provide a viable option for patients with comorbid disease.