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This study evaluated the interfacial adhesive strength between aluminium alloy and epoxy resin (Al/epoxy resin) over a wide range of strain rates (loading rates). We conducted three types of tests with different loading rate, i.e., a quasi-static tensile test for the range of lower loading rate, a Split Hopkinson Bar (SHB) for the range of middle loading rate, and Laser Shock Adhesion Test (LaSAT) for the range of higher loading rate. LaSAT is a unique test of adhesion evaluation, since laser induced shock wave is employed to lead interfacial fracture. In parallel, finite element method (FEM) is conducted in order to calculate stress distribution at the interface during LaSAT. As a result, it was found that the interface between the aluminium alloy and the epoxy resin interface shows significant loading rate dependency of the adhesion strength and this tendency is very similar to that of bulk epoxy materials.

Acute esophageal necrosis (AEN) is a rare disease characterized by the appearance of diffuse black mucosa on upper gastrointestinal endoscopy; the condition often progresses to esophageal stenosis in the chronic phase. A 70‐year‐old man was admitted to a neighborhood hospital with the diagnosis of alcoholic ketoacidosis and an upper gastrointestinal endoscopy performed to investigate the symptom of esophageal tightness revealed AEN. The patient developed esophageal stenosis with scarring in the chronic phase and was referred to our hospital for surgery 6 months after the diagnosis of AEN. We performed thoracoscopic esophagectomy with the patient in the prone position. Although the esophagus was thickened and strong adhesions were present around the esophagus due to inflammation, we were able to complete the surgical procedure thoracoscopically. In patients presenting with benign esophageal stenosis developing after AEN, thoracoscopic esophagectomy may be a useful treatment option, even in the presence of severe fibrosis. [ABSTRACT FROM AUTHOR]

Simple Summary: Esophageal squamous cell carcinoma with invasion to other organs/structures is considered unresectable, and its prognosis is extremely poor. In Japan, definitive chemoradiotherapy is often selected for cT4b cases, and regarded as the standard treatment option. In recent years, conversion surgery has been applied in some cases after downstage by induction therapy. In particular, DCF therapy consisting of docetaxel, cisplatin, and 5-fluorouracil has been reported effective for cT4b cases. Induction chemoradiotherapy, followed by conversion surgery, and salvage surgery after definitive chemoradiotherapy, have also been performed in selected patients. This article provides an overview of the contribution of multimodal treatment to improve oncological and survival outcomes for patients with locally advanced unresectable esophageal squamous cell carcinoma. Esophageal cancer is the seventh most common malignancy and sixth most common cause of cancer-related death globally. Esophageal squamous cell carcinoma (ESCC) with aortic or tracheal invasion is considered unresectable, and has an extremely poor prognosis; its standard treatment is definitive chemoradiotherapy (dCRT). In recent years, induction chemotherapy (ICT) has been reported to yield high response rates for locally advanced ESCC, and the efficacy and safety of ICT followed by conversion surgery (CS) have been investigated. Multimodal treatment, combining surgery with induction chemoradiotherapy (ICRT) or ICT, is necessary to improve ESCC prognosis. CS is generally performed for locally advanced ECC after ICRT or ICT when tumor downstaging is achieved, although its prognostic benefit remains controversial. The Japan Clinical Oncology Group (JCOG) has conducted a three-arm phase III randomized controlled trial (JCOG1510) to confirm the superiority of DCF (docetaxel, cisplatin, and 5-fluorouracil) ICT, over conventional dCRT, among patients with initially unresectable ESCC. In recent years, researchers have reported favorable outcomes of induction therapy followed by CS and salvage surgery, after dCRT or systemic immunochemotherapy. In this review, we will describe the latest developments in the multimodal treatment including chemotherapy, CRT, surgery, and immunotherapy, which may improve oncological and survival outcomes for patients with cT4 ESCC. [ABSTRACT FROM AUTHOR]

Objectives: There are few reports regarding minimally invasive aortic valve replacement concomitant with mitral valve surgery (MIAMVS). The aim of this study was to evaluate early and midterm MIAMVS results.Methods: We reviewed the medical records of 21 consecutive patients (nine females, 43%) who underwent MIAMVS through a right mini-thoracotomy from December 2014 to April 2017. Mean patient age was 73 ± 7.4 years and four (19%) were New York Heart Association Class III or IV. Aortic stenosis and mitral valve insufficiency were the most common pathologies. All patients were followed for a mean period of 30 ± 8.5 months.Results: The types of surgery consisted of aortic valve replacement with mitral valve repair in 11 (52%) patients, and replacement of both aortic and mitral valves in 10 (48%), while a tricuspid valve repair, was performed in four. No conversion to a full sternotomy was necessary in any of the cases. Postoperatively, the median intensive care unit and hospital stays were 4.7 and 11.8 days, respectively, with no in-hospital mortality. Following the initial treatment, all 21 patients were followed for a mean period of 30 ± 8.5 months (14-45 months). All patients returned to NYHA Class I or II following the procedure. During the follow-up period, there was no need for a heart valve reoperation for any of the patients and none showed recurrent mitral regurgitation (>mild), though one died from respiratory failure caused by pneumonia.Conclusions: MIAMVS can be performed via a right mini-thoracotomy, with acceptable early and midterm results expected. This may be a feasible alternative to the standard median sternotomy approach. [ABSTRACT FROM AUTHOR]

Background Robot-assisted thoracoscopic esophagectomy (RAMIE) is a precise and safe procedure with its advantages. On the other hand, RAMIE has several disadvantages. The lack of tactile function must be fully recognized, and surgical procedures must take the characteristics into account. We examined whether the findings obtained by intraoperative recurrent nerve monitoring (NIM) are useful in reducing recurrent laryngeal nerve paralysis (RLNP) after RAMIE. Methods Overall, 81 cases of RAMIE through February 2023 were included in the study. NIM was performed in 41 patients in the first term using a combination of continuous and intermittent methods (NIM group). In the subsequent 40 patients, NIM was not performed (non-NIM group) in order to confirm the learning effect of NIM and to shorten the operation time. RLNP was confirmed by a combination of symptoms and postoperative laryngoscopy. Clinical and oncological factors and short-term outcomes of the two groups were compared. Results All postoperative RLNP occurred on the left side. Six patients (14.6%) in the NIM group had Grade 1 or higher RLNP. The causes of RLNP were all found during thoracic manipulation; 4 cases of over-traction of RLN and 2 cases of crush injury by robotic forceps. There was a significant decrease in RLNP of Grade 2 or higher; 4 patients (9.7%) in the NIM group and 0 in the non-NIM group (p = 0.04). In the non-NIM group, there was a reduction in thoracic operative time, total operative time, and thoracic blood loss. Conclusion NIM made us aware of surgical maneuvers that cause RLNP after RAMIE. Although the proficiency of the RAMIE technique may have played a role in the reduction of RLNP in the later period, avoidance of risky surgical procedures due to the learning effect from the NIM was thought to have contributed to the decrease in RLNP. [ABSTRACT FROM AUTHOR]

Backgrounds Surgical algorithm for esophagogastric junction cancer have been proposed according to the results of a recent prospective study. However, reconstruction method has yet to be standardized. Esophagogastrostomy is often performed for esophagogastric junction cancer with esophageal invasion, although, it has been related to frequent and severe complications. Recently, we have introduced IntraThoracic Side-overlap EsophagoGastrostomy (ITS-EG), an eazy and novel intrathoracic anastomotic method with reflux prevention mechanism during minimally invasive esophagectomy for esophagogastric junction cancer. Methods We retrospectively reviewed patient backgrounds and surgical/short term outcomes for the patient who underwent ITS-EG during minimally invasive esophagectomy for esophagogastric junction cancer between February 2018 to April 2023 at our institute. Results The study cohort included ten patients, with a median age of 67 (55–77) years. All tumors were classified as Siewert type II, and the median esophageal invasion length was 32 (11.8–40) cm. After extended proximal gastrectomy, patients underwent either thoracoscopic (five patients) or robot-assisted (five patients) minimally invasive esophagectomy followed by ITS-EG. ITS-EG consist of overlap anastomosis utilizing surgical stapler, and reflux prevention mechanism owing to the creation of pseudo-fornix and a slit-shaped anastomosis. The initial case suffered anastomotic leakage, however, recovered by conservative measures. All the other patients had an uneventful recovery without reflux esophagitis nor anastomotic stricture. Conclusion ITS-EG is an easy and safe esophagogastric anastomosis with reflux prevention mechanism during minimally invasive esophagectomy, and may be considered for esophagogastric junction cancers with esophageal invasion. Further accumulation of cases is needed to demonstrate the safety and efficacy of ITS-EG. Surgical procedure for ITS-EG would be presented by video. [ABSTRACT FROM AUTHOR]

As transport vehicles, such as automobiles and aircraft, have become lighter and more efficiently, the use of resins to bond dissimilar materials has significantly increased. However, a natural oxide film and an hydroxide film are formed on metal surfaces, which alters adhesion characteristics. Sometimes, degradation of adhesion is accelerated by water molecules at the interface. Its mechanism is still not clear. In this study, the interface between a metal and resin was modeled by molecular dynamics (MD) simulation. Reaction force field (ReaxFF) was employed for MD simulations to investigate the effect of interfacial surface moisture (water molecules) on adhesion. The amount of water molecules at the interface was varied, and the effect of water molecules on adhesive strength under uniaxial tensile loading was investigated. In addition, the potential energy around the interface was calculated, and the adhesion mechanism with respect to water molecules was carefully discussed. • Adhesion strength of the aluminum alloy/epoxy resin interface increased when the surface was dried before adhesion. • MD simulation was conducted to understand the adhesion mechanism with respect to water molecules at the interface. • Increasing the amount of water molecules at the interface decreased the adhesive strength. • The bond at the interface affected the adhesive strength in relation to the water molecules. • MD simulation showed that water molecules encourage delamination at the interface. [ABSTRACT FROM AUTHOR]

Direct bonding of metals with resin plays a critical role in the jointing of dissimilar materials. The adhesion strength is known to be dependent on strain (loading) rate due to the strain rate sensitivity of polymeric resin. This study evaluated the adhesion durability of an epoxy resin adhesive on an aluminum alloy under cyclic impact loading. First, we used a repetitive laser shock adhesion test (LaSAT), which enabled us to evaluate the impact strength of interfacial fractures (i.e., adhesion and its durability). In this method, a pulsed YAG laser was used to generate strong elastic waves, which resulted in the interfacial fracture of the adhesive/aluminum alloy. We prepared two types of specimens with different curing temperatures (20 °C and 100 °C) and found that the specimen with the higher curing temperature showed higher adhesion strength and durability. We revealed that the adhesion strength showed cyclic fatigue characteristics, and that higher curing temperature improved fatigue strength. To elucidate this mechanism on the molecular level, we conducted a molecular dynamics (MD) simulation for the epoxy resin adhesive on aluminum alloy. The model featured an all-atom model of the Al 2 O 3 /epoxy resin interface, and we performed cyclic tensile deformation until delamination. We found that the number of loading cycles until delamination increased when the applied tensile stress was lower. We also found that the 400 K curing model had greater adhesion strength than the 300 K curing model. This tendency was confirmed by the results of the LaSAT experiments. Our comprehensive study incorporating LaSAT experiments and MD simulations evaluated adhesion strength and revealed its fracture mechanism. • Adhesion strength and durability for an aluminum alloy/epoxy resin adhesive were quantitatively evaluated using LaSAT. • The thermally cured specimen showed adhesive strength higher than that of the specimen cured at room temperature. • An all-atom MD simulation was used to reproduce an ultramicroscopic region near the epoxy resin/alumina interface. • Cyclic tensile deformation in the MD simulation led to interfacial fatigue fracture, with trends similar to the LaSAT. • MD simulation revealed the mechanism for interfacial fracture at the molecular-structure level. [ABSTRACT FROM AUTHOR]

We evaluated the adhesion of polycrystalline metallic coatings using the laser shock-wave adhesion test (LaSAT). This study used Cu plating on stainless steel as a coating model. The adhesion strength and toughness were successfully estimated using LaSAT and finite element method with cohesive zone model. Next, repeated LaSAT was conducted to apply cyclic loading to evaluate adhesion fatigue life, i.e., the number of loading cycles required for delamination. Furthermore, this study performed molecular dynamics (MD) simulations to elucidate the adhesion mechanism for the Cu/Fe interface. To verify our model, the interfacial fracture toughness was computed using the MD simulation and compared with the results of LaSAT. Next, cyclic loading was applied to the MD model to investigate crack initiation around the interface. We found that dislocations are generated from the internal grain and are accumulated at grain boundaries. This accumulation results in fatigue crack initiation due to stress concentration. [ABSTRACT FROM AUTHOR]

Simple Summary: In Japan, the therapeutic strategies for esophageal squamous cell carcinoma (ESCC) are based on the results of multi-institutional trials conducted by the Japan Esophageal Oncology Group (JEOG), a subgroup of the Japan Clinical Oncology Group (JCOG). Since there are several differences in the factors influencing the treatment approach for esophageal cancer between Eastern and Western countries, the therapeutic strategies adopted in Asian countries, especially Japan, are often different from those in Western countries. Because a transthoracic esophagectomy with three-field lymph node dissection has been performed as a standard surgical procedure for advanced thoracic ESCC in Japan, multimodal treatment for ESCC has been developed to improve the surgical outcomes after this relatively invasive surgical procedure. In this review, we describe the history and current status of therapeutic strategies for ESCC in Japan with a focus on the results of clinical trials conducted by the JEOG. In Japan, the therapeutic strategies adopted for esophageal carcinoma are based on the results of multi-institutional trials conducted by the Japan Esophageal Oncology Group (JEOG), a subgroup of the Japan Clinical Oncology Group (JCOG). Owing to the differences in the proportion of patients with squamous cell carcinoma among all patients with esophageal carcinoma, chemotherapeutic drugs available, and surgical procedures employed, the therapeutic strategies adopted in Asian countries, especially Japan, are often different from those in Western countries. The emphasis in respect of postoperative adjuvant therapy for patients with advanced esophageal squamous cell carcinoma (ESCC) shifted from postoperative radiotherapy in the 1980s to postoperative chemotherapy in the 1990s. In the 2000s, the optimal timing of administration of perioperative adjuvant chemotherapy returned from the postoperative adjuvant setting to the preoperative neoadjuvant setting. Recently, the JEOG commenced a three-arm randomized controlled trial of neoadjuvant therapies (cisplatin + 5-fluorouracil (CF) vs. CF + docetaxel (DCF) vs. CF + radiation therapy (41.4 Gy) (CRT)) for localized advanced ESCC, and patient recruitment has been completed. Salvage and conversion surgeries for ESCC have been developed in Japan, and the JEOG has conducted phase I/II trials to confirm the feasibility and safety of such aggressive surgeries. At present, the JEOG is conducting several trials for patients with resectable and unresectable ESCC, according to the tumor stage. Herein, we present a review of the JEOG trials conducted for advanced ESCC. [ABSTRACT FROM AUTHOR]

Immune checkpoint inhibitor therapy has dramatically improved patient prognosis, and thereby transformed the treatment in various cancer types including esophageal squamous cell carcinoma (ESCC) in the past decade. Monoclonal antibodies that selectively inhibit programmed cell death-1 (PD-1) activity has now become standard of care in the treatment of ESCC in metastatic settings, and has a high expectation to provide clinical benefit during perioperative period. Further, anti-cytotoxic T-lymphocyte-associated protein 4 (CTLA-4) monoclonal antibody has also been approved in the treatment of recurrent/metastatic ESCC in combination with anti-PD-1 antibody. Well understanding of the existing evidence of immune-based treatments for ESCC, as well as recent clinical trials on various combinations with chemotherapy for different clinical settings including neoadjuvant, adjuvant, and metastatic diseases, may provide future prospects of ESCC treatment for better patient outcomes., Competing Interests: Conflict-of-interest statement: The authors declare no conflict of interest., (©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.)

Background: The optimal postoperative surveillance protocol after esophagectomy for patients with esophageal cancer has still not been established. We investigated the risk factors for recurrence of esophageal cancer to devise an appropriate surveillance protocol. We focused on the appearance and worsening of symptoms to determine if additional imaging examinations should be performed., Study Design: We enrolled 416 patients with esophageal and esophagogastric junctional cancer who had undergone thoracoscopic esophagectomy at Tokai University Hospital. Outpatient visits for the patients are usually scheduled at least 4 times per year with CT imaging and blood biochemical examination. We evaluated the time to recurrence after esophagectomy, especially the correlation of this parameter with the appearance and worsening of symptoms during the postoperative outpatient follow-up., Results: Of the 416 patients, recurrence occurred in 127 patients (30.5%). The median time to recurrence was 6 months after esophagectomy; recurrence occurred within 24 months in 112 patients (88%), and 51 of these patients (40%) developed some new symptom(s) (symptomatic group) before the diagnosis of recurrence. The number of patients who developed recurrence within 6 months was significantly higher in the symptomatic group compared with that in the asymptomatic group (66.7% vs 46.0%, p = 0.02). The overall survival in the symptomatic group was significantly shorter than that in the asymptomatic group (p < 0.001)., Conclusions: We advocate an effective surveillance protocol depending on the appearance and worsening of symptoms to diagnose recurrence of esophageal cancer; we recommend routine imaging examinations every 6 months and clinical outpatient follow-up at even shorter intervals for the first 24 months after esophagectomy., (Copyright © 2023 by the American College of Surgeons. Published by Wolters Kluwer Health, Inc. All rights reserved.)

Incidence rates for esophagogastric junction cancer are rising rapidly worldwide possibly due to the economic development and demographic changes. Therefore, increased attention has been paid to the prevention, diagnosis, and the treatment of esophagogastric junction cancer. Although there are discrepancies in the treatment strategy between Asian and Western countries, surgery remains the mainstay of treatment for esophagogastric junction cancer. Recent developments of perioperative multidisciplinary treatment may lead to better therapeutic effect, higher complete resection rate, and better control of the residual diseases, thus result in prolonged prognosis. In this review, we will focus on the treatment of locally advanced resectable esophagogastric junction cancer, and discuss the current status and future perspectives of the perioperative treatment including chemotherapy, radiation therapy, and immunotherapy, as well as the surgical strategy. Better understanding of the latest treatment strategy and future overlook may enable to standardize and individualize the treatment for esophagogastric junction cancer, thus leading to better prognosis for those patients., Competing Interests: Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article., (©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.)

Esophageal cancer is the seventh most common malignancy and sixth most common cause of cancer-related death globally. Esophageal squamous cell carcinoma (ESCC) with aortic or tracheal invasion is considered unresectable, and has an extremely poor prognosis; its standard treatment is definitive chemoradiotherapy (dCRT). In recent years, induction chemotherapy (ICT) has been reported to yield high response rates for locally advanced ESCC, and the efficacy and safety of ICT followed by conversion surgery (CS) have been investigated. Multimodal treatment, combining surgery with induction chemoradiotherapy (ICRT) or ICT, is necessary to improve ESCC prognosis. CS is generally performed for locally advanced ECC after ICRT or ICT when tumor downstaging is achieved, although its prognostic benefit remains controversial. The Japan Clinical Oncology Group (JCOG) has conducted a three-arm phase III randomized controlled trial (JCOG1510) to confirm the superiority of DCF (docetaxel, cisplatin, and 5-fluorouracil) ICT, over conventional dCRT, among patients with initially unresectable ESCC. In recent years, researchers have reported favorable outcomes of induction therapy followed by CS and salvage surgery, after dCRT or systemic immunochemotherapy. In this review, we will describe the latest developments in the multimodal treatment including chemotherapy, CRT, surgery, and immunotherapy, which may improve oncological and survival outcomes for patients with cT4 ESCC., Competing Interests: The authors declare no conflict of interest.

Background/aim: In the Japanese Classification of Gastric Carcinoma, T4a gastric cancer is defined as tumor invasion contiguous to the serosa or penetrating the serosa with exposure to the peritoneal cavity. The aim of this study was to assess the impact of T4a subclassification of gastric cancer on survival., Patients and Methods: A total of 326 patients with T4a cancer who had undergone gastrectomy were enrolled. The T4a tumors were classified into two groups: serosa-contiguous or serosa-exposed., Results: The serosa-exposed group had a significantly worse prognosis, and multivariate analysis identified the T4a subclass as an independent prognostic factor. Analysis of the risk factors for recurrence identified the T4a subclass as a significant risk factor for peritoneal recurrence in patients undergoing curative gastrectomy., Conclusion: The serosa-contiguous and serosa-exposed subgroups of T4a gastric cancer showed different biological behaviors. These groups may need to be treated as separate., (Copyright © 2022, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.)

In Japan, the therapeutic strategies adopted for esophageal carcinoma are based on the results of multi-institutional trials conducted by the Japan Esophageal Oncology Group (JEOG), a subgroup of the Japan Clinical Oncology Group (JCOG). Owing to the differences in the proportion of patients with squamous cell carcinoma among all patients with esophageal carcinoma, chemotherapeutic drugs available, and surgical procedures employed, the therapeutic strategies adopted in Asian countries, especially Japan, are often different from those in Western countries. The emphasis in respect of postoperative adjuvant therapy for patients with advanced esophageal squamous cell carcinoma (ESCC) shifted from postoperative radiotherapy in the 1980s to postoperative chemotherapy in the 1990s. In the 2000s, the optimal timing of administration of perioperative adjuvant chemotherapy returned from the postoperative adjuvant setting to the preoperative neoadjuvant setting. Recently, the JEOG commenced a three-arm randomized controlled trial of neoadjuvant therapies (cisplatin + 5-fluorouracil (CF) vs. CF + docetaxel (DCF) vs. CF + radiation therapy (41.4 Gy) (CRT)) for localized advanced ESCC, and patient recruitment has been completed. Salvage and conversion surgeries for ESCC have been developed in Japan, and the JEOG has conducted phase I/II trials to confirm the feasibility and safety of such aggressive surgeries. At present, the JEOG is conducting several trials for patients with resectable and unresectable ESCC, according to the tumor stage. Herein, we present a review of the JEOG trials conducted for advanced ESCC.