Neoadjuvant Hyperthermia and Chemoradiotherapy for Borderline Resectable Pancreatic Cancer.

Pancreatic cancer(PC)is associated with poor prognosis and low resectability rates. Currently, only 15-20% of all patients are candidates for upfront surgery at the time of diagnosis, which offers the chance of long-term survival. In recent years, patients with borderline resectable PC(BR-PC)have been treated with surgery following neoadjuvant chemoradiotherapy or intensive multi-agent chemotherapy. In PC, which is therapy resistant due to its hypoxic microenvironment, hyperthermia may enhance the effect of chemo(radio)therapy. An 84-year-old man with fatty stool was diagnosed with pancreatic head cancer according to the result of contrast computed tomography(CT), which showed a 37 mm irregular low-density area at the pancreatic head infiltrating nearly half of the superior mesenteric artery(SMA)plexus. There were no findings of lymph node metastasis or distant metastasis. The pretreatment diagnosis was BR-PC, cT3, N0, M0, cStage Ⅱ A. The patient was treated with hyperthermia plus S-1 and radiotherapy. The size of the tumor had reduced from 37 mm to 15 mm after the neoadjuvant therapy, and the infiltration into the SMA plexus had also reduced. Therefore, the patient underwent subtotal stomach-preserving pancreaticoduodenectomy(SSPPD)concomitant resection of the PV, SMV, SV confluence. The histopathological findings were invasive ductal carcinoma with R0 radical resection. There has been no recurrence 18 months after the surgery. Based on the above-mentioned findings, hyperthermia and chemoradiotherapy can be an effective option of neoadjuvant treatment for BR-PC.

Improvement of Anal Function by Adipose-Derived Stem Cell Sheets.

AIM: One of the most troublesome complications of anal preserving surgery is anal sphincter dysfunction. The aim of this study was to evaluate functional recovery after implantation of adipose-derived stem cell (ADSC) sheets, novel biotechnology, for an anal sphincter resection animal model. METHODS: Eighteen female Sprague-Dawley rats underwent removal of the nearest half of the internal and external anal sphincter muscle. Nine rats received transplantation with ADSC sheets to the resected area while the remaining rats received no transplantation. The rats were evaluated for the anal function by measuring their resting pressure before surgery and on postoperative days 1, 7, 14, 28, and 56. In addition, the rats were examined for the presence of smooth muscle and also to determine its origin. RESULTS: The improvement of the anal pressure was significantly greater in the ADSC sheet transplantation group compared with the control group. Histologically, at the vicinity of the remaining smooth muscle, reproduction of smooth muscle was detected. Using in fluorescence in situ hybridization, the cells were shown to be from the recipient. CONCLUSION: Regenerative therapy using ADSC sheet has the potential to recover anal sphincter dysfunction due to anorectal surgery.

High incidence of recess formation at myopectineal orifice during laparoscopic surgery.

BACKGROUND: Groin hernias are frequently seen in clinical practice. The purpose of this study was to determine the rate of patients who might have latent groin hernia. METHODS: During laparoscopic abdominal surgery, we observed the area around the groin lesion and attempted to evaluate the degree of recess at myopectineal orifice. The classification defining the recess was as follows: Grade 0: no recess, Grade I: slight recess with a visible bottom, Grade II: deep recess with an invisible bottom, Grade III: other organ invaginated into the recess, and Grade IV: confirmed bulging on the body surface. RESULTS: From 2009 to 2011, 46 patients were enrolled. A recess around myopectineal orifice were detected in 20 patients. The lesions were as follows: 11 on the lateral side of the inferior epigastric artery (IEA), five on the internal side of the IEA, three at both sites and one found at the femoral ring. According to the grade classification of these groin hernias, 26 (57%) were Grade 0, 14 (30%) Grade I, 4 (9%) Grade II, 1 (2%) Grade III, and 1 (2%) Grade IV. CONCLUSIONS: This study showed that rate of patients with asymptomatic latent groin hernias is relatively high in Japanese.

Discordance of hormone receptor, human epidermal growth factor receptor-2, and Ki-67 between primary breast cancer and synchronous axillary lymph node metastasis.

PURPOSE: We herein report the discordance rate between primary breast cancer and synchronous axillary node metastasis, its characteristics and its prognostic impact. METHODS: One hundred and four patients with invasive breast cancer with synchronous axillary node metastasis who underwent surgery were included. Estrogen receptor (ER), progesterone receptor (PgR), human epidermal growth factor receptor-2 (HER2), and Ki-67 were stained by immunohistochemistry in both primary and node metastasis. The cut-off values of the ER/PgR and Ki-67 labeling index were set at 10% and 14%, respectively. HER2 was classified according to the ASCO/CAP guidelines. RESULTS: Cases positive for ER, PgR, and HER2 were 65.4%, 51.0%, and 27.9% and those with a high Ki-67 labeling index were 47.1% in primary breast cancer, respectively, while they were 47.1%, 30.8%, 16.3%, and 75.0% in node metastasis, respectively. The discordance rates between primary and node were 28.8% for ER (positive in primary→negative in node/negative→positive 22.1%/6.7%), 31.7% for PgR (26.9%/4.8%), 13.5% for HER2 (12.5%/1.0%), and 43.3% for Ki-67 (high in primary→low in node/low→high 12.5%/30.8%). The proportions of labeled cells in primary/node were as follows: ER 42.7%/25.2%, PgR 32.1%/14.0%, Ki-67 20.3%/37.1% (p<0.01 each). Regarding the cut-off value of Ki-67 in node metastasis as defined by a receiver operating characteristic (ROC) analysis, the patients with values >33.2% tended to have a poor recurrence-free survival (RFS) (p=0.08). CONCLUSIONS: The expression of hormone receptors tended to weaken while the proliferative status remained strong in axillary metastasis. A high Ki-67 labeling index in axillary lymph node metastasis may be a risk factor for recurrence.

Familiarity facilitates the corticocortical processing of face perception.

The visual evoked potentials elicited by mosaic pictures were used to elucidate the initial step of face perception. Three different mosaic levels (subthreshold, threshold, suprathreshold) for familiar and unfamiliar faces and objects were randomly presented for 250 ms. The latencies of occipital N1 and posterior-temporal N2 were shortened by decreasing the mosaic levels of faces but not for object. The N2 amplitude significantly increased at threshold and suprathreshold levels for familiar and unfamiliar faces. The latency difference between N1 and N2 at threshold level for a familiar face was significantly shortened compared with that for an unfamiliar face. Our findings suggest the initial step of face perception is already set in the primary visual cortex, and familiarity can facilitate the corticocortical processing of face information.