Equine chorionic gonadotropin treatment and timed artificial insemination for dairy cow production under heat stress.

This study investigated the effects of timed artificial insemination (TAI) and equine chorionic gonadotropin (eCG) administration on lactating dairy cows under heat-stress conditions (average temperature-humidity index: 80). Timed artificial insemination was performed on the cows with (n = 57) or without (control, n = 41) supplementation with 500 IU of eCG at the day of PGF2α treatment using the CIDR-Ovsynch protocol. GnRH was administered, and a progesterone device (CIDR) was inserted on Day -10 of the treatment protocol. The CIDR was removed on Day -3, and the cows were treated with PGF2α. Two days later, a 2nd GnRH injection was administered. Subsequently, AI was performed on Day 0 (16-20 h after the 2nd GnRH injection), and pregnancy was diagnosed on Days 32 and 60. Plasma progesterone (P4) concentrations were measured after AI. Results showed that the eCG group had a higher pregnancy per AI (P/AI) than the control group (43.9 vs. 12.2%, P = 0.002), which was also accompanied by elevated P4 levels. Four cows in the eCG group had multiple calves, representing 7.0 and 16.0% of the group and pregnant cows, respectively. In conclusion, 500 IU of eCG combined with CIDR-Ovsynch in lactating dairy cows under severe heat stress conditions successfully improved fertility. However, the protocol may have a slight risk of multiple births.

Clinicopathological study of surgically treated non-neoplastic diseases of the pancreas with special reference to autoimmune pancreatitis.

PURPOSE: After the popularization of serum immunoglobulin G4 (IgG4) measurement and endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) in our institute, surgical resection for non-neoplastic diseases of the pancreas became less common. Although the incidence of such false-positive cases was clarified in the 10-year period after the introduction of these measures (2009-2018), these data were not compared with the 30 years before 2009 (1979-2008). This study was performed to determine the percentage of autoimmune pancreatitis (AIP) that was included during the latter period and how the numbers of false-positive cases differed between the two periods. METHODS: From 1979 to 2008, 51 patients had clinical suspicion of pancreatic carcinoma (false-positive disease). Among these 51 patients, 32 non-alcoholic patients who had tumor-forming chronic pancreatitis (TFCP) were clinically, histologically, and immunohistochemically compared with 11 patients who had TFCP during the latter 10-year period. RESULTS: Retrospective IgG4 immunostaining of false-positive TFCP revealed 14 (35.0%) cases of AIP in the former 30 years versus 5 (45.5%) in the latter 10 years. There were 40 (5.9%) cases of TFCP among 675 patients in the former 30 years and 11 (0.9%) among 1289 patients in the latter 10 years. CONCLUSIONS: When the TFCP ratio of pancreatic resections and the AIP ratio of false-positive TFCPs were compared between the two periods, the TFCP ratio was 5.9% versus 0.9% and the AIP ratio was 35.0% versus 45.5%, respectively. It can thus be speculated that IgG4 measurement and EUS-FNA are absolutely imperative for the diagnosis of TFCP.

Purification and Characterization of the Lecithin-Dependent Thermolabile Hemolysin Vhe1 from the Vibrio sp. Strain MA3 Associated with Mass Mortality of Pearl Oyster (Pinctada fucata).

In a previous study, we isolated a Vibrio sp. strain MA3 and its virulence factor, a hemolysin encoded by vhe1. This strain is associated with mass mortalities of the pearl oyster Pinctada fucata. In the present study, the vhe1 gene from strain MA3 was cloned and its encoded product was purified and characterized. Our results show that the vhe1 gene encodes a protein of 417 amino acids with an estimated molecular mass of 47.2 kDa and a pI of 5.14. The deduced protein, Vhe1, was found to contain the conserved amino acid sequence (GDSL motif) of the hydrolase/esterase superfamily and five conserved blocks characteristic of SGNH hydrolases. A BLAST homology search indicated that Vhe1 belongs the lecithin-dependent hemolysin/thermolabile hemolysin (LDH/TLH) family. In activity analyses, the optimal temperature for both the hemolytic and phospholipase activities of Vhe1 was 50 °C. Vhe1 hemolytic activity and phospholipase activity were highest at pH 8.5 and pH 8.0, respectively. However, both enzymatic activities sharply decreased at high temperature (> 50 °C) and pH < 7.0. Compared with previously reported hemolysins, Vhe1 appeared to be more thermal- and pH-labile. Both its hemolytic activity and phospholipase activity were significantly inhibited by CuCl2, CdCl2, ZnCl2, and NiCl2, and slightly inhibited by MnCl2 and CoCl2. Vhe1 showed higher phospholipase activity toward medium-chain fatty acids (C8-C12) than toward shorter- and longer-chain fatty acids. These results accumulate knowledge about the LDH/TLH of V. alginolyticus, which detailed characterization has not been reported, and contribute to solving of the mass mortality of pearl oyster.

Development and evaluation of a rapid, specific, and sensitive loop-mediated isothermal amplification assay to detect Tenacibaculum sp. strain pbs-1 associated with black-spot shell disease in Akoya pearl oysters.

Black-spot shell disease decreases pearl quality and threatens pearl oyster survival. Establishment of a rapid, specific, and sensitive assay to detect Tenacibaculum sp. strain Pbs-1 associated with black-spot shell disease is of commercial importance. We developed a rapid, specific, and highly sensitive loop-mediated isothermal amplification (LAMP) assay to detect Tenacibaculum sp. Pbs-1 in Akoya pearl oysters Pinctada fucata. A set of five specific primers (two inner, two outer, and a loop) were designed based on the 16S-23S internal spacer region of strain Pbs-1. The optimum reaction temperature was 63 °C, and concentrations of the inner and loop primers were 1.4 and 1.0 µM, respectively. The LAMP product can be detected using agarose gel electrophoresis, and the color change in the reaction tube can be detected visually (by the naked eye) following the addition of malachite green. Our assay proved to be specific for strain Pbs-1, with no cross-reactivity with five other species of Tenacibaculum. The detection limit of the LAMP assay at 35 min is 50 pg, and at 60 min it is 5 fg. We evaluated the LAMP assay using diseased and healthy pearl oysters. The results demonstrate the suitability and simplicity of this test for rapid field diagnosis of strain Pbs-1.

[Sedation as a Part of Monitored Anesthesia Care (MAC) and Its Introduction to Japanese Clinical Practice].

To relieve or eliminate distress caused by invasive medical procedures, sedation is often used in routine clinical practice. Monitored anesthesia care (MAC) is needed in patients who receive increased doses of sedatives and/or analgesics, which may suppress the respiratory, cardiac, and/or vascular systems. Deep sedation, in particular, suppreses the nomal protective reflexes. It requires careful monitoring and intervention for patients. In Japan, sedation is performed in a large number of cases. It is unreasonable that only anesthesiologists administer MAC. In fact, sedation is often performed by non-anesthesiologists. In these circumstances, education and training for non-anesthesiologists are important

Inhibitors of LAMP used to detect Tenacibaculum sp. strain Pbs-1 associated with black-spot shell disease in Akoya pearl oysters, and additives to reduce the effect of the inhibitors.

Black-spot shell disease is an unresolved disease that decreases pearl quality and threatens pearl oyster survival. In previous studies, the bacterium Tenacibaculum sp. strain Pbs-1 was isolated from diseased Akoya pearl oysters Pinctada fucata, and a rapid, specific, and sensitive loop-mediated isothermal amplification (LAMP) assay for detecting this pathogen was established. This technology has considerable potential for routine diagnosis of strain Pbs-1 in oyster hatcheries and/or pearl farms; therefore, it is vital to identify substances in environmental samples that might inhibit LAMP and to find additives that can reduce the inhibition. In this study, we investigated the effects of six chemicals or proteins, otherwise known as conventional PCR inhibitors, on LAMP, using the DNA of strain Pbs-1 as template: humic acid, urea, iron (III) chloride hexahydrate, melanin, myoglobin, and Ethylenediamine-N,N,N',N'-tetraacetic acid, disodium salt, dihydrate (EDTA; pH 6.5). Next, to reduce the effects of identified inhibitors, we tested the addition of bovine serum albumin (BSA) or T4 gene 32 protein (gp32) to the LAMP assay. When 50 ng of DNA template was used, 4 ng/µL of humic acid, 0.05% melanin, and 10 mM of EDTA (pH 6.5) inhibited the LAMP reaction, whereas myoglobin, urea, and FeCl3 had no effect. When 50 pg of DNA template was used, 4 ng/µL of humic acid, 0.05% melanin, 4 µg/µL of myoglobin, 10 µg/µL of urea, and 10 mM of EDTA inhibited the LAMP reaction. Thus, it was shown that the gene-amplification inhibitory effect of melanin, humic acid, and urea could be reduced by adding BSA or gp32 to the LAMP reaction mixture. This technique could be applied as part of a protocol to prevent mass mortalities of pearl oysters; moreover, the results enhance our knowledge about substances that inhibit LAMP and methods to reduce the inhibition, which have rarely been reported.

Immunomodulatory Macrophages Enable E-MNC Therapy for Radiation-Induced Salivary Gland Hypofunction.

A newly developed therapy using effective-mononuclear cells (E-MNCs) is reportedly effective against radiation-damaged salivary glands (SGs) due to anti-inflammatory and revascularization effects. However, the cellular working mechanism of E-MNC therapy in SGs remains to be elucidated. In this study, E-MNCs were induced from peripheral blood mononuclear cells (PBMNCs) by culture for 5-7 days in medium supplemented with five specific recombinant proteins (5G-culture). We analyzed the anti-inflammatory characteristics of macrophage fraction of E-MNCs using a co-culture model with CD3/CD28-stimulated PBMNCs. To test therapeutic efficacy in vivo, either E-MNCs or E-MNCs depleted of CD11b-positive cells were transplanted intraglandularly into mice with radiation-damaged SGs. Following transplantation, SG function recovery and immunohistochemical analyses of harvested SGs were assessed to determine if CD11b-positive macrophages contributed to tissue regeneration. The results indicated that CD11b/CD206-positive (M2-like) macrophages were specifically induced in E-MNCs during 5G-culture, and Msr1- and galectin3-positive cells (immunomodulatory macrophages) were predominant. CD11b-positive fraction of E-MNCs significantly inhibited the expression of inflammation-related genes in CD3/CD28-stimulated PBMNCs. Transplanted E-MNCs exhibited a therapeutic effect on saliva secretion and reduced tissue fibrosis in radiation-damaged SGs, whereas E-MNCs depleted of CD11b-positive cells and radiated controls did not. Immunohistochemical analyses revealed HMGB1 phagocytosis and IGF1 secretion by CD11b/Msr1-positive macrophages from both transplanted E-MNCs and host M2-macrophages. Thus, the anti-inflammatory and tissue-regenerative effects observed in E-MNC therapy against radiation-damaged SGs can be partly explained by the immunomodulatory effect of M2-dominant macrophage fraction.

Effective-mononuclear cell (E-MNC) therapy alleviates salivary gland damage by suppressing lymphocyte infiltration in Sjögren-like disease.

Introduction: Sjögren syndrome (SS) is an autoimmune disease characterized by salivary gland (SG) destruction leading to loss of secretory function. A hallmark of the disease is the presence of focal lymphocyte infiltration in SGs, which is predominantly composed of T cells. Currently, there are no effective therapies for SS. Recently, we demonstrated that a newly developed therapy using effective-mononuclear cells (E-MNCs) improved the function of radiation-injured SGs due to anti-inflammatory and regenerative effects. In this study, we investigated whether E-MNCs could ameliorate disease development in non-obese diabetic (NOD) mice as a model for primary SS. Methods: E-MNCs were obtained from peripheral blood mononuclear cells (PBMNCs) cultured for 7 days in serum-free medium supplemented with five specific recombinant proteins (5G culture). The anti-inflammatory characteristics of E-MNCs were then analyzed using a co-culture system with CD3/CD28-stimulated PBMNCs. To evaluate the therapeutic efficacy of E-MNCs against SS onset, E-MNCs were transplanted into SGs of NOD mice. Subsequently, saliva secretion, histological, and gene expression analyses of harvested SG were performed to investigate if E-MNCs therapy delays disease development. Results: First, we characterized that both human and mouse E-MNCs exhibited induction of CD11b/CD206-positive cells (M2 macrophages) and that human E-MNCs could inhibit inflammatory gene expressions in CD3/CD28- stimulated PBMNCs. Further analyses revealed that Msr1-and galectin3-positive macrophages (immunomodulatory M2c phenotype) were specifically induced in E-MNCs of both NOD and MHC class I-matched mice. Transplanted E-MNCs induced M2 macrophages and reduced the expression of T cell-derived chemokine-related and inflammatory genes in SG tissue of NOD mice at SS-onset. Then, E-MNCs suppressed the infiltration of CD4-positive T cells and facilitated the maintenance of saliva secretion for up to 12 weeks after E-MNC administration. Discussion: Thus, the immunomodulatory actions of E-MNCs could be part of a therapeutic strategy targeting the early stage of primary SS.

Significance of anatomic resection for early and advanced hepatocellular carcinoma.

PURPOSE: Although it remains controversial whether local ablation or surgery is better for early-stage hepatocellular carcinoma (HCC), surgical resection is the first choice for advanced HCC. Anatomic hepatic resection is the preferred procedure to improve prognosis, but to date, its superiority has been demonstrated only for early-stage HCC. This study aimed to evaluate the effect of anatomic resection in advanced HCC in which surgical resection is the first choice. METHODS: The prognosis of 210 patients who underwent curative resection for primary HCC was analyzed. Sixty-three patients with no more than three tumors, none of which were larger than 3 cm in diameter, and with no macroscopic vascular invasion were classified as early HCC (group E); the other 147 patients were classified as advanced HCC (group A). RESULTS: The 5-year survival rate was better in group E (73% vs. 55%, P < 0.01), but the 5-year recurrence-free survival rate was equivalent between the two groups (E vs. A; 30% vs. 32%, P = 0.19). Multivariate analysis showed that independent predictors of good survival in group E were indocyanine green retention rate at 15 min ≤20% [hazard ratio (HR) = 0.30; 95% confidential interval (CI), 0.10-0.88) and tumor differentiation grade of well or moderate or complete necrosis (HR = 0.14; 95% CI, 0.03-0.95), while predictors in group A were anatomic resection (HR = 0.48; 95% CI, 02.27-0.85) and no macroscopic vascular invasion (HR = 0.35; 95% CI, 0.17-0.72). CONCLUSION: For advanced HCC, anatomic resection should be performed to improve patient prognosis.

Impact of previous hepatectomy on short-term outcomes of repeat hepatectomy for liver tumors with a special concern of operative time.

BACKGROUND/AIMS: Repeat hepatectomy is widely accepted as a treatment for primary or metastatic liver malignancy. However, it entails a longer operative time and is associated with additional operative risks. The goal of the present study was to evaluate the impact of previous hepatectomy on the short-term outcomes of repeat hepatectomy, especially in operative time. METHODOLOGY: A retrospective review of prospectively collected data from patients who underwent primary hepatectomy (n=166) and repeat hepatectomy (n=65) in a single institution. RESULTS: Operative time was significantly longer for repeat hepatectomy than for primary hepatectomy (284min vs. 250min, p=0.04). There were no significant differences between the two groups with respect to intraoperative blood loss, intraoperative blood transfusion, morbidity, mortality and length of hospital stay. Multivariate analysis demonstrated that third or subsequent hepatectomy and tumor location in the caudate lobe at the repeat hepatectomy significantly prolonged operative time. CONCLUSIONS: Repeat hepatectomy has similar short-term outcomes to primary liver resection. However, repeat hepatectomy is a time-consuming operation, especially in patients with tumors in the caudate lobe or for those undergoing their third or subsequent hepatectomy.

Is hepatic resection for recurrent or persistent hepatocellular carcinoma justified?

BACKGROUND/AIMS: The safety and effectiveness of hepatic resection for recurrent or refractory hepatocellular is not established, particularly in cases treated by non-surgical treatment. METHODOLOGY: Surgical outcomes of 38 patients who underwent curative hepatic resection for recurrent or refractory disease after previous treatment were evaluated. Univariate and multivariate analyses were performed to identify prognostic predictors. RESULTS: There were no postoperative deaths, morbidity occurred in 9 patients (prolonged ascites retention, 5; biliary fistula, 3; intraabdominal abscess, 1), and all of them were treated conservatively. Recurrence-free and overall 1, 3 and 5-year-survival rate was 54, 28 and 24%, and 78, 60 and 55%, respectively. Multivariate analysis revealed hepatitis B or C virus infection (HR=12.8; 95% CI=2.3-245.1), tumor size >5 cm (HR=5.9; 95% CI=5.9-25.6), and vasculo- biliary invasion (HR=5.2; 95% CI=1.4-21.0) were independent predictors of poor overall survival. Type of previous treatment did not influence prognosis. CONCLUSIONS: Hepatic resection for recurrent or refractory hepatocellular carcinoma is safe and achieves long survival in selected patients.

Preoperative transarterial chemoembolization for hepatocellular carcinoma.

BACKGROUND/AIMS: The effects of transarterial chemoembolization (TACE) prior to hepatectomy for patients with hepatocellular carcinoma (HCC) are controversial. METHODOLOGY: Clinicopathological profiles and prognosis were compared between patients who underwent hepatic resection following preoperative TACE (Group A, 69 patients) or only resection (Group B, 158 patients). Univariate and multivariate analyses were used to evaluate whether TACE influenced patient prognosis. RESULTS: Profiles of Group A were comparable with those of Group B except for younger age, higher frequency of major hepatectomy, higher incidence of positive surgical margin, vascular invasion and poorly differentiated HCC. Overall survival was significantly worse in Group A than in Group B (5-year survival rate; 29% vs. 69%; p<0.001). A subset of patients in Group A with complete tumor necrosis by TACE showed comparable survival with Group B. Multivariate analysis revealed that preoperative TACE (hazard ratio (HR)=4.3; 95% confidential interval (CI), 2.8-6.6), non-anatomic resection (HR=1.6; 95% CI, 1.1-2.4), blood loss >1L (HR=1.8; 95% CI=1.1-2.8) and vascular invasion (HR=2.3; 95% CI=1.4-3.6) were independent predictors of poor survival. Preoperative TACE was also an independent predictor of extrahepatic metastases (odds ratio, 2.8; 95% CI=1.1-7.1). CONCLUSIONS: Preoperative TACE should not be routinely applied for HCC.

Mesenteric fibromatosis of the transverse colon with the reconstruction of the superior mesenteric arteries: report of a case.

In general, with large mesenteric tumors it may be rather difficult to determine whether infiltration into adjacent large vessels occurred. We wish to stress the importance of preparation for microsurgery when a huge lesion appears close to a large artery in preoperative images, based on our experience of successful microscopical reconstruction of a superior mesenteric artery (SMA) and marked improvement of blocked vascular flow to the small intestine during the surgery. We have experienced a case of mesenteric fibromatosis (MF) invading the SMA and vein, contrary to preoperative expectation. The patient underwent extirpation of a MF, 21 cm in size, with reconstruction of the SMA by microsurgery. The sacrificed small intestine was only 80 cm of the distal ileum with the benefit of microscopic anastomosis between the SMA and a major jejunal artery. Preparations for microscopic surgery must be made with resection of large lesions, because involvement of mesenteric large vessels may be expected. It is possible for microsurgery to extend indications for surgical resection of huge mesenteric tumors.

Predictive factors for bile leakage after hepatectomy: analysis of 505 consecutive patients.

BACKGROUND: Bile leakage is the most common complication after hepatectomy and its incidence is not declining. The aim of the present study was to identify predictive factors for bile leakage. METHODS: Clinical data from 505 consecutive patients who underwent hepatectomy without extrahepatic bile duct resection in our department between January 2006 and December 2009 were reviewed retrospectively. RESULTS: The incidence of bile leakage was found to be 6.7%. Multivariate analysis identified three independent factors that were significantly correlated with the occurrence of bile leakage: (1) repeat hepatectomy (P = 0.002; odds ratio [OR] 3.439; 95% confidence interval [CI] 1.552-7.618), (2) a cut surface area ≥57.5 cm(2) (P = 0.004; OR 5.296; 95% CI 1.721-16.302), and (3) intraoperative blood loss ≥775 ml (P = 0.01; OR 2.808; 95% CI 1.280-6.160). CONCLUSION: More meticulous management is needed to prevent bile leakage in high-risk patients.

Repeat treatment for recurrent hepatocellular carcinoma: is it validated?

PURPOSE: Hepatocellular carcinoma (HCC) usually recurs repeatedly and locoregional treatment is attempted unless liver function has deteriorated. This study was aimed to evaluate the effect of repeated treatment on patient prognosis. METHODS: The HCC recurrence pattern and types of treatment for recurrence after hepatic resection were reviewed in 134 patients. The effects of repeated treatment on prognosis were evaluated. Univariate and multivariate analyses were performed to determine the prognostic predictors after initial recurrence. RESULTS: Median number of treatments after recurrence was 3 (range, 0-12). Transarterial chemoembolization was the most common treatment. The number of treatments, but not the type of treatment, was associated with the prognosis. Multivariate analysis showed that a >20% indocyanine green retention rate at 15 min (hazard ratio [HR] = 2.65; 95% confidential interval [CI], 1.53-5.62), size of primary tumor >5 cm (HR = 1.81; 95% CI, 1.05-3.08), recurrence-free interval <1 year (HR = 2.17; 95% CI, 1.28-3.81), size of recurrent tumor >3 cm (HR = 2.61; 95% CI, 1.03-5.77-0.95), and extrahepatic recurrence (HR = 6.35; 95% CI, 3.49-11.39) were independent predictors of poor survival. CONCLUSION: The prognosis after recurrence is poor in cases with large tumors or poor liver function. Repeated locoregional treatment contributes to prolong patient prognosis, especially in cases with a small tumor size, long recurrence-free interval, and no extrahepatic metastases.

Direct Conversion of Human Fibroblasts into Adipocytes Using a Novel Small Molecular Compound: Implications for Regenerative Therapy for Adipose Tissue Defects.

There is a need in plastic surgery to prepare autologous adipocytes that can be transplanted in patients to reconstruct soft tissue defects caused by tumor resection, including breast cancer, and by trauma and other diseases. Direct conversion of somatic cells into adipocytes may allow sufficient functional adipocytes to be obtained for use in regeneration therapy. Chemical libraries of 10,800 molecules were screened for the ability to induce lipid accumulation in human dermal fibroblasts (HDFs) in culture. Chemical compound-mediated directly converted adipocytes (CCCAs) were characterized by lipid staining, immunostaining, and qRT-PCR, and were also tested for adipokine secretion and glucose uptake. CCCAs were also implanted into mice to examine their distribution in vivo. STK287794 was identified as a small molecule that induced the accumulation of lipid droplets in HDFs. CCCAs expressed adipocyte-related genes, secreted adiponectin and leptin, and abundantly incorporated glucose. After implantation in mice, CCCAs resided in granulation tissue and remained adipose-like. HDFs were successfully converted into adipocytes by adding a single chemical compound, STK287794. C/EBPα and PPARγ were upregulated in STK287794-treated cells, which strongly suggests involvement of these adipocyte-related transcription factors in the chemical direct conversion. Our method may be useful for the preparation of autogenous adipocytes for transplantation therapy for soft tissue defects and fat tissue atrophy.

Improved survival of left-sided pancreas cancer after surgery.

OBJECTIVE: Resective therapeutic strategy for left-sided pancreatic adenocarcinoma is open to debate. The post-resection outcomes and factors influencing post-resection survival for adenocarcinoma of the body and tail of the pancreas were analyzed to determine the effectiveness of surgery. METHODS: A total of 73 patients with adenocarcinoma of the body or tail of the pancreas who underwent resection between 1994 and June 2007 were evaluated for overall survival. RESULTS: Multiple malignancies were present in 34 of 73 patients (47%). Overall 1-, 3- and 5-year survival rates after surgery were 79%, 34%, and 30%, respectively. Presence of symptoms, multiple cancers and level of preoperative tumor marker did not influence post-resection survival. As for tumor characteristics, tumor size, histological tumor differentiation, retroperitoneal invasion, status of residual tumor and UICC staging represented significant prognostic indicators by univariate analysis. Gemcitabine, when administered as an adjuvant settings, strongly worked for improving post-resection outcome (5-year survival rate = 51%). Factors shown to have independent prognostic significance on multivariate analysis were tumor size (<3 vs. >or=3 cm), status of residual tumor (R0 vs. R1, 2), and postoperative administration of gemcitabine. CONCLUSIONS: Appropriate patient selection and accurate surgical technique with postoperative adjuvant therapy could benefit survival of patients with carcinoma of the pancreas body and tail.

Risk factors for clinical pancreatic fistula after distal pancreatectomy: analysis of consecutive 100 patients.

BACKGROUND: The mortality associated with distal pancreatectomy (DP) has declined to <5% in recent years in high-volume centers. However, morbidity remains high, ranging from 32% to 57%. Pancreatic fistula (PF) is the most common complication after DP. The aim of this study was to analyze factors associated with the occurrence of clinical PF. METHODS: A retrospective review was performed of the medical records of 100 patients who underwent DP in our institution between May 2001 and January 2009. RESULTS: There was no mortality, but morbidity was occurred in 65 patients (65%), with major complications occurring in 9 patients (9%). PF occurred in 50 patients (50%) and clinical PF occurred in 23 patients (23%). Multivariate analysis indicated that independent risk factors for clinical PF were: age younger than 65 years (P = 0.049; odds ratio (OR) 2.958; 95% confidence interval (CI) 1.007-8.688), not ligating the main pancreatic duct (MPD) (P = 0.02; OR 4.933; 95% CI 1.283-18.967), and extended lymphadenectomy (P = 0.008; OR 4.773; 95% CI 1.504-15.145). CONCLUSIONS: Age < 65 years, not ligating the MPD, and extended lymphadenectomy are independent risk factors for clinical PF.

Widespread and multifocal carcinomas in situ (CISs) through almost the entire pancreas: report of a case with preoperative cytological diagnosis.

PURPOSE: It is imperative for prognostic improvement of pancreatic cancer that we try to diagnose carcinoma in situ (CIS) of lesions, i.e., precursors of invasive ductal carcinomas (IDCs) at an early stage, because results of treatment of patients with IDCs themselves continue to be rather unsatisfactory. MATERIALS AND RESULTS: We report here a case of a patient who received subtotal pancreatectomy for widespread and multifocal CISs of the pancreas after preoperative brushing cytology from the epithelium of dilated main pancreatic duct proved cancer-positive preoperatively. CONCLUSIONS: From our experience, we conclude that examination for CIS of the pancreas must be recommended whenever dilatation of relatively large pancreatic ducts is found by ultrasound or computed tomography. We should therefore advance to magnetic resonance cholangiopancreatography or endoscopic retrograde cholangiopancreatography and then cytological and/or pathological assessment of the pancreatic duct whenever non-continuous narrowing, localized dilatation, or other irregularities are encountered.

Immunohistochemical localization of aquaporin-4 in the rat pituitary gland.

Aquaporin-4 (AQP4) is an isoform of membrane water channel aquaporins. It is most abundant in the brain, and is believed to be expressed by astrocytes and ependymal cells. We have reported previously that rat pituitary glands express some aquaporin subtypes, including AQP4, but the precise distribution of AQP4 in the pituitary gland is not known. The present work investigated whether AQP4 immunoreactivity exists in various pituitary cell types in adult rats, using double immunofluorescent staining and confocal microscopy. In the adenohypophysis, co-labeling for S-100 protein indicated that folliculo-stellate (FS) cells and marginal layer cells in Rathke's residual pouch have extensive labeling for AQP4. Some AQP4-expressing cells also contained glial fibrillary acidic protein (GFAP) in parenchymal tissue of the anterior lobe, and cytokeratin in marginal layer cells. AQP4 was not coexpressed in any hormone-producing pituitary cells, however. In the neurohypophysis, AQP4 was expressed in some pituicytes, which have been identified as GFAP-positive. These results suggest that AQP4, which is expressed in FS cells, in marginal layer cells and in pituicytes, but not in hormone-producing cells, is important in water transfer within the pituitary gland; astrocytes and ependymal cells do the same in the brain.