[Results of Surgical Treatment for Gastric Cancer in the Elderly Over 85 Years Old].

Although the number of gastric cancers in elderly is increasing with the aging population, the indications of surgical treatment depend on the individual cases and the decisions of doctors. We investigated the outcomes of gastrectomy in elderly patients aged 85 years and older who underwent surgery at our hospital. From 2014 to 2022, 72 cases of gastrectomy were performed in the elderly. The approaches were laparotomy in 28 cases, laparoscopic in 42, and robot-assisted in 2. There were 57 cases of distal gastrectomy, 7 cases of proximal gastrectomy, and 8 cases of total gastrectomy. The median operation time was 200 minutes, and the postoperative hospital stay was 14 days. There were 14 cases of complications of Grade Ⅱ or higher according to the Clavien-Dindo classification. Although intra-abdominal complications were not many, respiratory and circulatory complications were occasionally observed. The median follow-up period was 14.6 months, there were 10 deaths from other diseases. Risk factors for death from other diseases were laparotomy, postoperative complications, and outcomes other than discharging home. Although gastrectomy may be performed safely even in the elderly, it is important to pay attention to the patients' conditions particular to the elderly and to plan the surgery accordingly.

Cadmium accumulation dynamics in the rice endosperm during grain filling revealed by autoradiography.

Cadmium (Cd) is one of the environmental pollutants contaminated in our food. Several previous reports showed that rice polishing cannot be efficient to reduce Cd content in white rice, implying the characteristic Cd distribution in rice grain. However, Cd distribution has not been fully elucidated so far. Herein, 109Cd radiotracer experiment was performed using the rice seedlings at various time points after flowering to obtain autoradiographs of the brown rice to visually understand the Cd transport and distribution during the grain-filling process. It was shown that 109Cd accumulated in the outermost area of the brown rice, and also in the middle part of the starchy endosperm, resulting in the appearance of the double circle distribution pattern, which was not observed in the autoradiographs of 65Zn. The inner circle of 109Cd located around the center of the endosperm was developed particularly at around 8 and 10 days after flowering. After this period, 109Cd started to deposit at the outer part of the endosperm, which was also found in the autoradiograph of 14C-sucrose. Considering the physiology of grain development, the contribution of water transport and protein synthesis in the endosperm on the characteristic Cd distribution pattern was hypothesized.

Starch-dependent sodium accumulation in the leaves of Vigna riukiuensis.

This research provides insight into a unique salt tolerance mechanism of Vigna riukiuensis. V. riukiuensis is one of the salt-tolerant species identified from the genus Vigna. We have previously reported that V. riukiuensis accumulates a higher amount of sodium in the leaves, whereas V. nakashimae, a close relative of V. riukiuensis, suppresses sodium allocation to the leaves. We first suspected that V. riukiuensis would have developed vacuoles for sodium sequestration, but there were no differences compared to a salt-sensitive species V. angularis. However, many starch granules were observed in the chloroplasts of V. riukiuensis. In addition, forced degradation of leaf starch by shading treatment resulted in no radio-Na (22Na) accumulation in the leaves. We performed SEM-EDX to locate Na in leaf sections and detected Na in chloroplasts of V. riukiuensis, especially around the starch granules but not in the middle of. Our results could provide the second evidence of the Na-trapping system by starch granules, following the case of common reed that accumulates starch granule at the shoot base for binding Na.

[A Case of Primary Somatostatin-Producing Tumor of the Duodenum with Liver Metastases with Long-Term Survival of More than 20 Years].

A 52-year-old woman underwent esophagogastroduodenoscopy after an abnormal medical examination, which revealed a mass lesion over half the circumference of the superior duodenal angulus. Immunostaining was diffusely positive for somatostatin, synaptophysin, and chromogranin A. A 3 cm-sized mass in the pancreaticoduodenal region and multiple nodular lesions of a few mm in both lobes of the liver were revealed by CT. The diagnosis is primary somatostatin-producing tumor of the duodenum with multiple liver metastases. She underwent gastric jejunal bypass for impaired transit. Afterwards hepatic infusion and systemic chemotherapy were continued, and 5 years passed without progression. When she stopped chemotherapy for 6 months, she started somatostatin analogue therapy because of the increase of the tumors. The tumors did not increase, and 20 years have passed since the start of treatment. We report a case of primary somatostatin-producing tumor of the duodenum with liver metastases that is still alive for a long period of time, with a review of the literature.

Visualization of phosphorus re-translocation and phosphate transporter expression profiles in a shortened annual cycle system of poplar.

Phosphorus (P) is an essential macronutrient for plant growth. In deciduous trees, P is remobilized from senescing leaves and stored in perennial tissues during winter for further growth. Annual internal recycling and accumulation of P are considered an important strategy to support the vigorous growth of trees. However, the pathways of seasonal re-translocation of P and the molecular mechanisms of this transport have not been clarified. Here we show the seasonal P re-translocation route visualized using real-time radioisotope imaging and the macro- and micro-autoradiography. We analysed the seasonal re-translocation P in poplar (Populus alba. L) cultivated under 'a shortened annual cycle system', which mimicked seasonal phenology in a laboratory. From growing to senescing season, sink tissues of 32 P and/or 33 P shifted from young leaves and the apex to the lower stem and roots. The radioisotope P re-translocated from a leaf was stored in phloem and xylem parenchyma cells and redistributed to new shoots after dormancy. Seasonal expression profile of phosphate transporters (PHT1, PHT5 and PHO1 family) was obtained in the same system. Our results reveal the seasonal P re-translocation routes at the organ and tissue levels and provide a foothold for elucidating its molecular mechanisms.

Diversity of Na+ allocation in salt-tolerant species of the genus Vigna.

Wild species in the genus Vigna are a great resource of tolerance to various stresses including salinity. We have previously screened the genetic resources of the genus Vigna and identified several accessions that have independently evolved salt tolerance. However, many aspects of such tolerance have remained unknown. Thus, we used autoradiography with radioactive sodium (22Na+) and Inductively Coupled Plasma Mass Spectrometry (ICP-MS) to visualize and compare Na+ allocation in Vigna angularis (Willd.) Ohwi & H.Ohashi (azuki bean), Vigna nakashimae (Ohwi) Ohwi & H.Ohashi, Vigna riukiuensis (Ohwi) Ohwi & H.Ohashi, Vigna luteola (Jacq.) Benth. and Vigna marina (Burm.) Merr.. The results indicated: 1) Tolerant accessions suppress Na+ accumulation compared to azuki bean. 2) V. nakashimae and V. marina does so by accumulating higher amount of K+, whereas V. riukiuensis and V. luteola does so by other mechanisms. 3) V. luteola avoids salt-shedding by allocating excess Na+ to newly expanded leaves. As the mechanisms of the tolerant species were different, they could be piled up in a single crop via classical breeding or by genetic engineering or genome editing.

Clinical features of patients with pancreatic ductal adenocarcinoma with a history of other primary malignancies: A retrospective analysis.

Patients with pancreatic ductal adenocarcinoma (PDAC) that have a history of other primary malignancies are not well documented. The current study therefore aimed to evaluate the clinicopathological characteristics of patients with PDAC with or without a history of other primary malignancies. A total of 102 patients with surgically treated PDAC that presented with or without a history of other primary malignancies were retrospectively analyzed. A total of 25 patients (24.5%) had a history of other primary malignancies (age, with history of other primary malignancy vs. without, 74.2 vs. 68.9 years; P=0.005) and the reason for consultation (P<0.001) differed significantly between the groups with a history of other primary malignancies [HoM(+)] and without a history of other primary malignancies [HoM(-)]. Incidental indications during malignancy follow-up was the most common reason for the diagnosis of PDAC in the HoM(+) group. Conversely, there were no significant differences in the resectability (P=0.645), complete resection rate (P=0.774) and final stage (P=0.474) between the two groups. Disease-free survival was also not significantly different between the two groups (P=0.184). However, overall survival was significantly poorer in the HoM(+) group compared with the HoM(-) group (P=0.003). A history of other primary malignancies was also an independent predictor of poor overall survival (hazard ratio, 2.416; 95% confidence interval, 1.324-4.406; P=0.004). In conclusion, patients with PDAC and a history of other primary malignancies had significantly poorer overall survival than their counterparts, despite no differences in disease-free survival.

[Laparoscopy Assisted Subtotal Gastrectomy(Billrothâ Reconstruction)for Gastric Cancer in the Upper Stomach-A Report of Three Cases].

We experienced 3 cases of upper gastric cancer who underwent BillrothⅠ reconstruction in laparoscopy assisted subtotal gastrectomy. Two cases were female and 1 was male. The postoperative course was uneventful in all cases without heartburn, and the surgical margin was negative. The body weight loss rate was 5.8-12.6%, and the short-term results were relatively acceptable. Although the number of cases in this study was small, reconstruction with BillrothⅠ/delta-shaped anastomosis after laparoscopy assisted subtotal gastrectomy were considered to be useful.

Comparison of three fistula risk scores after pancreatoduodenectomy: A single-institution retrospective study.

BACKGROUND: Postoperative pancreatic fistula (POPF) after pancreatoduodenectomy greatly influences patients' postoperative course. Several evaluation methods have been used to assess the risk of clinically relevant POPF (CR-POPF) after pancreatoduodenectomy namely, the original, alternative, and updated alternative fistula risk scores (o-FRS, a-FRS, and ua-FRS, respectively). METHODS: We enrolled 106/179 patients who underwent pancreatoduodenectomy in our institution between April 2013 and Mar 2018. CR-POPF was defined as grade B and C POPF according to the 2016 definitions of the International Study Group on Pancreatic Surgery. RESULTS: Pancreatic gland texture was the only significant risk factor for CR-POPF (p = 0.007). The CR-POPF incidence increased significantly according to the risk groups defined by both o-FRS (p = 0.004) and a-FRS (p = 0.004). The area under the curve for o-FRS, a-FRS, and ua-FRS was 0.693, 0.693, and 0.671, respectively. CONCLUSION: o-FRS, a-FRS, and ua-FRS were almost equally useful for risk evaluation for CR-POPF after pancreatoduodenectomy. Further studies, especially for preoperative objective evaluation of pancreatic gland texture, are needed for more useful and accurate risk evaluation.

Radiocesium transfer rates among pigs fed haylage contaminated with low levels of cesium at two differentiation stages.

The objective of this study was to determine the radiocesium transfer rates of pigs fed haylage contaminated with low levels of cesium at different growth stages. We measured the body weight of juvenile and adult pigs during the treatment period to confirm their health status. We also performed pig blood hematologic and biochemical analyses at both growth stages. To our knowledge, this is the first study to report pig radiocesium transfer coefficient rates after 1 month of chronic oral treatment, which is the period assumed to be required for body equilibrium under a diet of radiocesium-contaminated food. The results showed higher radiocesium retention rates in the kidneys, liver, spleen, genitals, psoas major, bladder, thyroid, and urine than in the blood and bone (tibia and femur) of pigs at both growth stages. The radiocesium retention levels were generally higher in juvenile pigs than in adult pigs, with the highest transfer coefficient ratio in the kidneys (16.2%).

[A Case of a Huge Gastrointestinal Stromal Tumor with Extraluminal Growth Arising in the Small Intestine Diagnosed as an Ovarian Tumor].

We report a case of a gastrointenstinal stromal tumor(GIST)of the small intestine with extraluminal growth that was difficult to distinguish from an ovarian tumor. A 73-year-old woman presented to a nearby hospital for lower abdominal pain. A computed tomography(CT)scan showed a 17 cm ovarian tumor in the pelvis, and she was referred to the gynecology department of our hospital. Following examinations(enhanced CT and magnetic resonance imaging), she was referred to our department in suspicion of a small intestinal GIST in which the superior mesenteric artery/vein was the feeding blood vessel, and intraperitoneal tumor resection was performed. A large cystic tumor occupied the abdominal cavity and was in contact with the small intestinal wall. As the tumor was not in contact with the uterus or bilateral adnexa, only partial resection of the small intestine was performed. Histopathological examination showed c-kit positivity and she was diagnosed with small intestinal GIST; as a result, a course of imatinib was started.

[A Case of Colon Cancer with Brain, Liver and Lung Metastasis Successfully Treated with Bevacizumab plus Xelox Therapy].

The patient was a 57-year-old woman. Preclinical examination of malignant lymphoma revealed 0-I sp type of early rectal cancer in the upper rectum, 20 cm from the anal margin. Endoscopic mucosal resection was performed and positive deep margins were pathologically diagnosed. Additional intestinal resection with lymph node dissection was deemed necessary, but ABVD therapy was initiated because the clinical stage of the malignant lymphoma was Stage III b or higher. Two months after detecting elevated CEA, S8 liver metastasis was pointed out, and examination of weakness of the right upper limb revealed nodular, multifocal brain metastasis. After chemotherapy for malignant lymphoma, bevacizumab(BV)plus Xelox therapy was initiated. After administering 4 courses, partial loss of multiple brain metastases and reduction of the liver metastatic lesion were confirmed; therefore, partial resection of the liver via laparoscopy was performed. After surgery, BV plus Xelox therapy was resumed, but since the lower lobular lung metastasis was confirmed after 8 courses, partial resection of the left lower lobe with thoracoscopy was performed. After lung resection, BV plus FOLFIRI therapy was administered, and 12 months after the onset of treatment for brain metastasis, recurrence was not detected.

Phase I study of weekly palliative chemotherapy with low-dose third-line paclitaxel for biliary tract cancer.

The prognosis of patients with unresectable and recurrent biliary tract cancer (BTC) is very poor. Although gemcitabine (GEM) plus cisplatin therapy is useful for unresectable cases, the median overall survival (OS) of the patients is <1 year, and third-line chemotherapy following failure of 5-fluorouracil (5-FU) and GEM plus cisplatin is currently unavailable. The clinical efficacy and basic effects of low-dose paclitaxel (PTX) therapy for patients with BTC was previously reported. We herein present the results of a phase I clinical trial of weekly low-dose PTX as third-line palliative chemotherapy. PTX was administered on days 1, 8, 15 and 22 of each cycle and repeated twice as follows: Level 1, 40 mg/m2; level 2, 50 mg/m2 (n=3). During the two cycles, grade 1 or 2 adverse events were observed in 3 patients, whereas dose-limiting adverse events (grade 3 or 4) were not observed. The disease control rate was 83.3% (partial response, n=3; stable disease, n=2). The OS and median survival were 15.4 and 9.0 months, respectively. In conclusion, palliative chemotherapy with low-dose PTX following failure of GEM and 5-FU was well-tolerated, safe and effective for patients with unresectable or recurrent BTCs, and the optimal dose was 50 mg/m2.

[A Case of Pneumocystis Pneumonia Developed during Chemotherapy for Sigmoid Colon Cancer].

A 69-year-old man with multiple liver metastases from sigmoid colon cancer received mFOLFOX6 plus cetuximab(Cmab) chemotherapy. A partial response was observed; hence, we performed an extended left hepatectomy, 3 partial liver resections, and a sigmoidectomy. After 4 courses of CapeOX, a recurrent lesion occurred between S8 and S7 of the liver, and we changed the regimen to FOLFIRI plus bevacizumab(BV). Three months later, he had Grade 3 febrile neutropenia and CT scan findings showed ground glass opacity in the superior lobes of both lungs. We diagnosed pneumocystis pneumonia(PCP)and administered steroids and trimethoprim/sulfamethoxazole. The signs of PCP thus improved. PCP during chemotherapy for gastrointestinal cancer is rarely reported, but recently it has increased.

Short day length-induced decrease of cesium uptake without altering potassium uptake manner in poplar.

Short day length-induced alteration of potassium (K) localization in perennial trees is believed to be a mechanism for surviving and adapting to severe winters. To investigate the relationship between cesium (Cs) and K localizations, a model tree poplar, hybrid aspen T89, was employed. Under short day length conditions, the amount of 137Cs absorbed through the root and translocated to the root was drastically reduced, but 42K was not. Potassium uptake from the rhizosphere is mediated mainly by KUP/HAK/KT and CNGC transporters. In poplar, however, these genes were constantly expressed under short-day conditions except for a slight increase in the expression a KUP/HAK/KT gene six weeks after the onset of the short-day treatment. These results indicated that the suppression of 137Cs uptake was triggered by short day length but not regulated by competitive Cs+ and K+ transport. We hypothesize that there are separately regulated Cs+ and K+ transport systems in poplar.

Expression status of CD44 and CD133 as a prognostic marker in esophageal squamous cell carcinoma treated with neoadjuvant chemotherapy followed by radical esophagectomy.

Cancer stem cells (CSCs) have self-renewal and pluripotency capabilities and contribute to cancer progression and chemoresistance. It has been proposed that the treatment resistance and heterogeneity of CSCs are deeply involved in the prognosis of patients with esophageal squamous cell carcinoma (ESCC). The objective of this study was to identify the influence of the expression status of the CSC markers CD44 and CD133 on chemotherapeutic efficacy and prognosis in ESCC patients who underwent radical esophagectomy after neoadjuvant chemotherapy (NAC). Endoscopically biopsied specimens taken before NAC and surgically resected specimens after NAC were immunohistochemically assessed for CD44 and CD133 expression for 47 ESCC patients who underwent NAC followed by radical esophagectomy. The correlation between CD44 and CD133 expression status and clinicopathological findings and the prognosis of ESCC patients after NAC followed by esophagectomy were analyzed. The percentages of CD44-positive cells and CD133-positive cells in specimens were increased after NAC. CD44 and CD133 expression status before NAC did not correlate with the degree of tumor progression and had no impact on the chemotherapeutic effect. However, strong expression of CD44 or CD133 and a high proportion of CD133-expressing cells before NAC were significantly associated with poorer esophageal cancer-specific survival. Patients with strong expression of CD44 or CD133 and those with a high ratio of CD133-positive tumor cells showed significantly poor prognosis regardless of the effect of chemotherapy. Multivariate analysis showed that simultaneous strong expression of CD44 and CD133 before NAC, a high rate of CD133-positive tumor cells before NAC, and primary tumor remission assessed by preoperative endoscopy were significant independent prognostic factors for ESCC. Our data indicate that CD44 and CD133 expression status prior to treatment dictates the malignant potential of ESCC and may be a novel predictor of recurrence and prognosis of ESCC patients after treatment.

Effects of rabeprazole on bone metabolic disorders in a gastrectomized rat model.

Proton pump inhibitors (PPIs) are frequently prescribed to patients with gastroesophageal reflux disease; however, the number of bone fractures reportedly increased in these patients. Although PPIs have been shown to inhibit the bone resorption by osteoclasts, the effect of PPIs on skeletal metabolism remains controversial. The aim of the present study was to determine the effect of the PPI rabeprazole on skeletal metabolism using gastrectomized rats. Male Wistar rats were divided into four groups: i) Sham-surgery (n=15); ii) total gastrectomy (TG) control (n=20); iii) TG plus rabeprazole (n=20); and iv) TG plus the bisphosphonate minodronic acid (n=20). Twenty-two weeks after TG, the rats were sacrificed, and bone mineral density (BMD), bone strength and markers for bone metabolism were measured. Compared with the control group (50.0±8.1%), the TG-induced decrease in BMD was significantly ameliorated in the rabeprazole group (56.5±7.5%) and the minodronic acid group (59.0±6.0%). However, rabeprazole did not improve bone strength. In conclusion, rabeprazole does not appear to exacerbate bone metabolic disorders in gastrectomized rats, but rather ameliorates the TG-induced BMD decrease.

Visualization of Uptake of Mineral Elements and the Dynamics of Photosynthates in Arabidopsis by a Newly Developed Real-Time Radioisotope Imaging System (RRIS).

Minerals and photosynthates are essential for many plant processes, but their imaging in live plants is difficult. We have developed a method for their live imaging in Arabidopsis using a real-time radioisotope imaging system. When each radioisotope,(22)Na,(28)Mg,(32)P-phosphate,(35)S-sulfate,(42)K,(45)Ca,(54)Mn and(137)Cs, was employed as an ion tracer, ion movement from root to shoot over 24 h was clearly observed. The movements of(22)Na,(42)K,(32)P,(35)S and(137)Cs were fast so that they spread to the tip of stems. In contrast, high accumulation of(28)Mg,(45)Ca and(54)Mn was found in the basal part of the main stem. Based on this time-course analysis, the velocity of ion movement in the main stem was calculated, and found to be fastest for S and K among the ions we tested in this study. Furthermore, application of a heat-girdling treatment allowed determination of individual ion movement via xylem flow alone, excluding phloem flow, within the main stem of 43-day-old Arabidopsis inflorescences. We also successfully developed a new system for visualizing photosynthates using labeled carbon dioxide,(14)CO2 Using this system, the switching of source/sink organs and phloem flow direction could be monitored in parts of whole shoots and over time. In roots,(14)C photosynthates accumulated intensively in the growing root tip area, 200-800 µm behind the meristem. These results show that this real-time radioisotope imaging system allows visualization of many nuclides over a long time-course and thus constitutes a powerful tool for the analysis of various physiological phenomena.

Cesium adsorption/desorption behavior of clay minerals considering actual contamination conditions in Fukushima.

Cesium adsorption/desorption experiments for various clay minerals, considering actual contamination conditions in Fukushima, were conducted using the (137)Cs radioisotope and an autoradiography using imaging plates (IPs). A 50 µl solution containing 0.185 ~ 1.85 Bq of (137)Cs (10(-11) ~ 10(-9 )molL(-1) of (137)Cs) was dropped onto a substrate where various mineral particles were arranged. It was found that partially-vermiculitized biotite, which is termed "weathered biotite" (WB) in this study, from Fukushima sorbed (137)Cs far more than the other clay minerals (fresh biotite, illite, smectite, kaolinite, halloysite, allophane, imogolite) on the same substrate. When WB was absent on the substrate, the amount of (137)Cs sorbed to the other clay minerals was considerably increased, implying that selective sorption to WB caused depletion of radiocesium in the solution and less sorption to the coexisting minerals. Cs-sorption to WB continued for about one day, whereas that to ferruginous smectite was completed within one hour. The sorbed (137)Cs in WB was hardly leached with hydrochloric acid at pH 1, particularly in samples with a longer sorption time. The presence/absence of WB sorbing radiocesium is a key factor affecting the dynamics and fate of radiocesium in Fukushima.

[Therapeutic Strategies with Multidisciplinary Local Therapy for Postoperative Recurrence of Esophageal Cancer].

We report our experience with tailored treatment comprising resection or radiotherapy for postoperative recurrence of esophageal cancer in 73 patients(35.4%)who were diagnosed with recurrent esophageal cancer after curative resection. The initial recurrence patterns included 7 patients(3.4%)with local recurrence, 38 patients(18.4%)with lymphatic recurrence, 40 patients(19.4%)with hematologic metastases, and 12 patients(5.8%)with dissemination.Twenty -three patients had solitary lung metastases, and good local control was achieved by surgical resection alone.The success rate of intensity modulated radiation therapy (IMRT) for local control was 64.1%, and IMRT was considered effective and less invasive. The 2-year survival rate after successful treatment for recurrence was 53.5%, vs 5.8% after unsuccessful treatment. Improved prognosis for patients with recurrent esophageal cancer can be expected when adequate local control is achieved according to recurrence pattern by surgical resection or IMRT.