[Six Cases of Esophagogastric Junctional Cancer Successfully Treated with Neoadjuvant Chemotherapy].

Neoadjuvant chemotherapy(NAC)is prescribed for resectable esophagogastric junctional cancer on the basis of esophageal invasion length, lymph node metastasis, and pathological diagnosis. Due to a lack of consensus in Japan, however, discussion regarding its use is necessary. This study comprised 6 patients who underwent surgical resection after receiving NAC in our department from 2018 to 2022. All the patients were male, with a median age of 67 years. Three patients underwent SP therapy, 2 received SOX therapy, and 1 received both SOX and HER therapy. A total gastrectomy was performed in 3 cases, a fundectomy in 1 case, and a subtotal esophagectomy with gastric tube reconstruction in 2 cases. The histological types were tub2 in 3 cases; and tub1 plus pap, por1 plus pap, and NEC in 1 case each, respectively. One case was ypStage ⅠA, 2 cases were ⅠB, 1 was ⅡA, 1 was ⅡB and 1 was pCR. Currently, all the patients remain alive and without recurrence. NAC has, therefore, been demonstrated to be an effective therapeutic strategy for esophagogastric junctional cancer in this study. However, further research with a larger sample size is required.

Conversion surgery for stage IV gastric cancer: a multicenter retrospective study.

BACKGROUND: Recent improvements in systemic chemotherapy have provided an opportunity for patients with stage IV gastric cancer (GC) to undergo conversion surgery (CS). The aim of this study was to evaluate the long-term outcomes of patients who underwent CS and to elucidate the prognostic factors for CS in stage IV GC. METHODS: A total of 79 patients who underwent CS with the aim of R0 resection for stage IV GC at six institutions from January 2008 to July 2019 were enrolled. We retrospectively reviewed the clinicopathological data and prognosis. RESULTS: Of the 79 patients, 23 (31.1%) had initially resectable disease (IR) before chemotherapy, defined as positive for cancer on peritoneal cytology (CY1), resectable hepatic metastasis, or para-aortic lymph node No. 16a2/b1 metastasis. Of the 56 remaining patients with primary unresectable disease, 39 had peritoneal dissemination. R0 resection was accomplished in 63 patients (79.7%). The 3-year OS rates for patients with IR and unresectable disease were 78.3% and 44.5%, respectively. Multivariate analysis showed that IR (P = 0.014) and R0 (P = 0.014) were statistically significant independent prognostic factors for favorable OS. Among patients with peritoneal dissemination alone, OS was significantly better for patients with R0 resection than for patients with R1/2 resection, with the 3-year OS rates of 65.5% and 23.1%, respectively (P = 0.011). CONCLUSIONS: CS is a treatment option for selected patients with stage IV GC. Patients with IR and patients who achieve R0 resection may obtain a survival benefit from CS.

Well-differentiated liposarcoma causing non-islet cell tumor hypoglycemia.

Non-islet cell tumor hypoglycemia (NICTH) is a paraneoplastic syndrome that causes severe hypoglycemia. The tumor involved produces high-molecular-weight insulin-like growth factor-II (IGF-II). NICTH can be caused by various benign and malignant tumors. However, NICTH due to liposarcoma (LPS) is rare. A 38-year-old man was brought to the hospital emergency department with complaints of vomiting and unconsciousness. His abdomen was distended, and a large tumor was palpable. He had severe hypoglycemia that required continuous glucose infusion. Radiological examination revealed a large 40-cm mass that filled the abdominal cavity, and LPS of the mesentery was suspected. Laboratory data showed low levels of insulin, C-peptide, and IGF-I concentrations. Subsequently, an LPS-induced NICTH was suspected. Complete resection of the tumor and the encased small intestine was performed. The pathological diagnosis was well-differentiated liposarcoma (WDLPS). The Western immunoblot showed that the high-molecular-weight IGF-II confirmed in the serum preoperatively, had almost disappeared postoperatively. Based on these findings, NICTH caused by a WDLPS was diagnosed. The postoperative course was uneventful. In the last 4 years since the primary operation, the patient had not experienced further hypoglycemia symptoms. Here, we report a case of NICTH caused by a large WDLPS. NICTH should be considered in patients with both severe hypoglycemia and large tumors. In these cases, appropriate treatment including semi-urgent surgery should be provided.

Morphology and Electric Conductance Change Induced by Voltage Pulse Excitation in (GeTe)2/Sb2Te3 Superlattices.

Chalcogenide superlattice (SL) phase-change memory materials are leading candidates for non-volatile, energy-efficient electric memory where the electric conductance switching is caused by the atom repositioning in the constituent layers. Here, we study the time evolution of the electric conductance in [(GeTe)2/(Sb2Te3)1]4 SLs upon the application of an external pulsed electric field by analysing the structural and electrical responses of the SL films with scanning probe microscopy (SPM) and scanning probe lithography (SPL). At a low pulse voltage (1.6-2.3 V), a conductance switching delay of a few seconds was observed in some SL areas, where the switch to the high conductance state (HCS) is accompanied with an SL expansion under the strong electric field of the SPM probe. At a high pulse voltage (2.5-3.0 V), the HCS current was unstable and decayed in a few seconds; this is ascribed to the degradation of the HCS crystal phase under excessive heating. The reversible conductance change under a pulse voltage of opposite polarity emphasised the role of the electric field in the phase-transition mechanism.

Advanced gastric glandular-endocrine cell carcinoma with 1-year survival after gastrectomy.

Primary gastric endocrine cell carcinoma (ECC) is extremely rare. In general, when it is advanced, gastric ECC causes extensive ulceration (type 2) and invades or metastasizes to other organs, frequently to the liver and sometimes to the lungs or bones, and carries a poor prognosis. We herein report a 67-year-old man with advanced gastric ECC of extensive-polypoid shape (type 1) but without distant metastasis, who underwent total gastrectomy and treatment with oral tegafur-uracil (UFT), and showed no sign of recurrence 1 year later.

Conservative treatment of esophageal perforation related to a peptic ulcer with pyloric stenosis.

We report a case of esophageal perforation (Boerhaave syndrome) caused by vomiting related to a duodenal ulcer with pyloric stenosis. A 45-year-old male presented with left chest pain and dyspnea after forceful vomiting. Chest radiography and computed tomography (CT) revealed a massive left pleural effusion and left tension pneumothorax. Abdominal CT revealed pyloric stenosis with a remarkably dilated stomach. Tube thoracostomy and nasogastric suction were immediately performed and we selected conservative treatment based on the following factors-a stable general condition without sepsis, early diagnosis, and good drainage. Esophagogastroduodenoscopy on hospital day 9 demonstrated a healing ulcer in the lower esophagus and pyloric stenosis. We performed distal gastrectomy as elective surgery for pyloric stenosis due to a duodenal ulcer on hospital day 30. In summary, an esophageal perforation with contamination spreading to the thoracic cavity was successfully treated with conservative treatment.

Diagnosis of ischemic small bowel disease by measurement of serum intestinal fatty acid-binding protein in patients with acute abdomen: a multicenter, observer-blinded validation study.

BACKGROUND: Intestinal fatty acid-binding protein (I-FABP) is a low-molecular-mass (15 kDa) cytosolic protein found exclusively in the epithelial cells of the small bowel mucosa. We aimed to evaluate the clinical usefulness of serum I-FABP measurement for the diagnosis of ischemic small bowel disease. METHODS: Patients with a clinical diagnosis of acute abdomen were recruited for this multicenter trial at one university hospital and nine city hospitals over a 13-month period. Serum I-FABP levels were measured in 361 eligible patients by an enzyme-linked immunosorbent assay using a specific monoclonal antibody. RESULTS: Of the 361 patients, 242 underwent surgery, and small bowel ischemia was diagnosed in 52 patients. The mean serum I-FABP level in the patients with small bowel ischemia was 40.7 ± 117.9 ng/ml, which was significantly higher than that in patients with non-ischemic small bowel disease (5.8 ± 15.6 ng/ml) and those with non-small bowel disease (1.8 ± 1.7 ng/ml). The serum I-FABP cutoff level for the diagnosis of small bowel ischemia was 3.1 ng/ml. Serum I-FABP was more efficient than conventional biochemical markers, in terms of sensitivity and positive and negative predictive values, in the diagnosis of small bowel ischemia. However, its specificity was slightly lower than that of creatinine phosphokinase or lactate dehydrogenase. The positive and negative likelihood ratios of serum I-FABP were 3.01 and 0.29, respectively. CONCLUSION: Serum I-FABP measurement is a non-invasive method that is potentially useful for the efficient identification of patients with acute abdomen who are at risk of small bowel ischemia.

A microrotary motor powered by bacteria.

Biological molecular motors have a number of unique advantages over artificial motors, including efficient conversion of chemical energy into mechanical work and the potential for self-assembly into larger structures, as is seen in muscle sarcomeres and bacterial and eukaryotic flagella. The development of an appropriate interface between such biological materials and synthetic devices should enable us to realize useful hybrid micromachines. Here we describe a microrotary motor composed of a 20-mum-diameter silicon dioxide rotor driven on a silicon track by the gliding bacterium Mycoplasma mobile. This motor is fueled by glucose and inherits some of the properties normally attributed to living systems.