New diagnostic strategy using narrow-band imaging (NBI) during laparoscopic surgery for patients with colorectal cancer.

BACKGROUND: Accurate tumor stage diagnosis during laparoscopic surgery remains difficult. We clarify the impact of new diagnostic strategy using narrow-band imaging (NBI) during laparoscopic surgery for colorectal cancer compared with other strategies. METHODS: We defined angiogenesis (Ag) and fibrosis (Fib) grades using NBI laparoscopy (lap-NBI), and assessed the clinicopathological features associated with these grades for 67 patients with colorectal cancer who underwent surgery. We assessed vessel density and gray scale with computer software. RESULTS: NBI-Ag-grade and NBI-Fib-grade of the serosal surface of cancer lesions and peritoneal nodules correlated with vessel density and gray scale of those assessed by Image J computer software. NBI-Fib-grades of liver nodules also correlated with gray scale. NBI-Ag- grade and Fib-grade of the serosal surface of cancer lesions correlated with pathological depth of invasion. These NBI grades of pathological metastatic peritoneal nodules were higher than those of pathologically benign peritoneal nodules. NBI- Fib grades of pathological metastatic liver nodules were higher than those of pathologically benign liver nodules. In multivariate analysis, lap-NBI was associated with different diagnosis for T3, T4 and non-T3, and non-T4. Moreover, lap-NBI was associated with different diagnosis for T4 and non-T4. Predictive value for T4 by lap-NBI showed high sensitivity (85%) specificity (87%), positive predictive value (74%), negative predictive value (93%), and overall accuracy (87%). Sensitivity and overall accuracy of lap-NBI was superior to that of other diagnostic modalities. CONCLUSION: We clarified the usefulness of the new diagnostic strategy using lap-NBI during laparoscopic surgery for colorectal cancer in comparison with other strategies.

Design and on-orbit operation of the Soft X-ray Spectrometer ADR on the Hitomi Observatory.

The Soft X-ray Spectrometer (SXS) instrument that flew on the Astro-H observatory was designed to perform imaging and spectroscopy of x-rays in the energy range of 0.2 to 13 keV with a resolution requirement of 7 eV or better. This was accomplished using a 6x6 array of x-ray microcalorimeters cooled to an operating temperature of 50 mK by an adiabatic demagnetization refrigerator (ADR). The ADR consisted of three stages in order to operate using either a 1.2 K superfluid helium bath or a 4.5 K Joule-Thomson (JT) cryocooler as its heat sink. The design was based on the following operating strategy. After launch, while liquid helium was present (cryogen mode), two of the ADR's stages would be used to single-shot cool the detectors, using the helium as a heat sink. When the helium was eventually depleted (cryogen-free mode), all three ADR stages would be used to continuously cool the helium tank to about 1.5 K, and to single-shot cool the detectors (to 50 mK), using the JT cryocooler as a heat sink. The Astro-H observatory, renamed Hitomi after its successful launch in February 2016, carried approximately 36 liters of helium into orbit. Based on measurements during ground testing, the average heat load on the helium was projected to be 0.66 mW, giving a lifetime of more than 4 years. On day 5, the helium had cooled to <1.4 K and ADR operation began, successfully cooling the detector array to 50 mK. The ADR's hold time steadily increased to 48 hours as the helium cooled to a temperature of 1.12 K. As the commissioning phase progressed, the ADR was recycled (requiring approximately 45 minutes) periodically, either in preparation for science observations or whenever the 50 mK stage approached the end of its hold time. In total, 18 cycles were completed by the time an attitude control anomaly led to an unrecoverable failure of the satellite on day 38. This paper presents the design, operation and on-orbit performance of the ADR in cryogen mode as the foreshortened mission did not provide an opportunity to test cryogen-free mode.

Laparoscopic and endoscopic cooperative surgery is a feasible treatment procedure for intraluminal gastric gastrointestinal stromal tumors compared to endoscopic intragastric surgery.

BACKGROUND: Laparoscopic wedge resection of the stomach is an ideal procedure if the gastric gastrointestinal stromal tumors (GISTs) are located in the extraluminal stomach. When the tumor is located in the intraluminal stomach, two minimally invasive surgical procedures involving laparoscopic and endoscopic cooperative surgery (LECS) or endoscopic intragastric surgery (EIGS) are frequently performed. To date, there have been no comparative studies of LECS and EIGS in patients with intraluminal gastric GISTs regarding short-term and long-term outcomes. The aim of this study was to compare the safety and feasibility of LECS and EIGS in patients with intraluminal gastric GISTs. METHODS: This was a single-center retrospective study of 46 consecutive patients with intraluminal gastric GISTs who underwent minimally invasive surgery. LECS (n = 21) was performed between 2013 and 2015 and EIGS (n = 26) was performed between 2001 and 2013. RESULTS: The overall incidence of perioperative complications was significantly higher in the EIGS group than in the LECS group (40 vs 4.8%; P = 0.006). In the EIGS group, three patients with intraoperative gastric mucosal injury were followed-up throughout surgical repair (12%). An esophageal tear was found in one patient during oral removal of tumor (4%). Postoperative gastric hemorrhage occurred in three patients (12%) and superficial surgical site infection was observed in three patients (12%). In the LECS group, anastomotic leakage requiring additional drainage was observed in one patient (4.8%). EIGS had less favorable results regarding median time to resumption of first oral intake (2 vs 1 days; P = 0.005). Two of 46 patients (4.3%), including one patient who underwent LECS and one patient who underwent EIGS developed recurrence. No cause-specific deaths were observed. CONCLUSION: LECS is a feasible and safe procedure for intraluminal gastric GISTs with regard to both short-term surgical and long-term oncological outcomes. Registration number: UMIN000026631.

Impact of the post/preoperative serum CEA ratio on the survival of patients with rectal cancer.

PURPOSE: This study demonstrated the usefulness of the post/preoperative serum carcinoembryonic antigen (CEA) ratio as a predictor of survival after surgery for stage III rectal cancer patients. METHODS: One hundred and four patients with stage III rectal cancer who underwent surgery between 1991 and 2000 were enrolled. The ratio of the postoperative serum CEA value divided by the preoperative serum CEA value was defined as post/preoperative serum CEA ratio, and the patients were separated into two groups: post/preoperative serum CEA ratio ≤ 1 (n = 86) and >1 (n = 18). RESULTS: The multivariate analyses demonstrated that the intraoperative blood loss, lack of a sphincter-saving procedure and a post/preoperative serum CEA ratio >1 were independent factors predicting a poor prognosis for the overall and disease-free survival. The overall and disease-free survival rates among patients with a high preoperative serum CEA level (>5 ng/ml) or patients with a high postoperative serum CEA (>5 ng/ml) were longer in patients with a post/preoperative serum CEA ratio ≤ 1, in comparison to those with a post/preoperative serum CEA ratio >1. Liver metastasis was observed more frequently in patients with a post/preoperative serum CEA ratio >1. CONCLUSIONS: The post/preoperative serum CEA ratio may be a predictor of the prognosis after surgery for stage III rectal cancer patients.

Baryons at the edge of the X-ray-brightest galaxy cluster.

Studies of the diffuse x-ray-emitting gas in galaxy clusters have provided powerful constraints on cosmological parameters and insights into plasma astrophysics. However, measurements of the faint cluster outskirts have become possible only recently. Using data from the Suzaku x-ray telescope, we determined an accurate, spatially resolved census of the gas, metals, and dark matter out to the edge of the Perseus Cluster. Contrary to previous results, our measurements of the cluster baryon fraction are consistent with the expected universal value at half of the virial radius. The apparent baryon fraction exceeds the cosmic mean at larger radii, suggesting a clumpy distribution of the gas, which is important for understanding the ongoing growth of clusters from the surrounding cosmic web.