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We undertook genomic analyses of Japanese patients with stage I esophageal squamous cell carcinoma (ESCC) to investigate the frequency of genomic alterations and the association with survival outcomes. Biomarker analysis was carried out for patients with clinical stage T1bN0M0 ESCC enrolled in JCOG0502 (UMIN000000551). Whole-exome sequencing (WES) was performed using DNA extracted from formalin-fixed, paraffin-embedded tissue of ESCC and normal tissue or blood sample. Single nucleotide variants (SNVs), insertions/deletions (indels), and copy number alterations (CNAs) were identified. We then evaluated the associations between each gene alteration with a frequency of 10% or more and progression-free survival (PFS) using a Cox regression model. We controlled for family-wise errors at 0.05 using the Bonferroni method. Among the 379 patients who were enrolled in JCOG0502, 127 patients were successfully analyzed using WES. The median patient age was 63 years (interquartile range, 57-67 years), and 78.0% of the patients ultimately underwent surgery. The 3-year PFS probability was 76.3%. We detected 20 genes with SNVs, indels, or amplifications with a frequency of 10% or more. Genomic alterations in FGF19 showed the strongest association with PFS with a borderline level of statistical significance of P = .00252 (Bonferroni-adjusted significance level is .0025). Genomic alterations in FGF4, MYEOV, CTTN, and ORAOV1 showed a marginal association with PFS (P .05). These genomic alterations were all CNAs at chromosome 11q13.3. We have identified new genomic alterations associated with the poor efficacy of ESCC (T1bN0M0). These findings open avenues for the development of new potential treatments for patients with ESCC.

Background Previous studies have suggested that patients with esophageal squamous cell carcinoma (ESCC) are still at a high risk of developing second primary malignancies (SPMs) after definitive therapies. We evaluated the development of SPMs and explored its risk factors in patients with clinical T1bN0 ESCC. Methods JCOG0502 prospectively compared esophagectomy with definitive chemo-radiotherapy for clinical T1bN0 ESCC. Here, we reviewed all JCOG0502 patients’ data for SPMs and investigated the risk factors for SPMs using uni-variable and multivariable analyses by Fine and Gray model. Results Among 379 enrolled patients, 213 underwent esophagectomy and 166 received chemo-radiotherapy. Patient characteristics were male (85%); median age [63 (range 41–75) years; location of the primary tumor (upper/middle/lower thoracic esophagus, 11%/63%/27%, respectively]; alcohol consumption history (79%); smoking history (66%); prevalence of no/several/many/unknown Lugol-voiding lesions (LVLs) (45%/36%/8%/11%, respectively). In a median follow-up of 7.1 years, 118 SPMs occurred in 99 (26%) patients. Cumulative incidences of SPMs after 3, 5, and 10 years were 9%, 15%, and 36%, respectively. The most common primary tumor sites were the head and neck (35%), stomach (20%) and lungs (14%). In multivariable analyses, compared to no LVLs, several LVLs [hazard ratio (HR) 2.24, 95% confidential interval (CI) 1.32–3.81] and many LVLs (HR 2.88, 95% CI 1.27–6.52) were significantly associated with the development of SPMs. Sixteen patients died due to the SPMs. Conclusion The incidence of SPMs was high. The presence of LVLs, which was a predictive factor for SPMs, may be useful for surveillance planning.

Clinical N category (cN) is generally assessed by measuring the nodal diameter by CT before the initiation of primary treatment in esophageal squamous cell carcinoma (ESCC). The short-axis diameter is recommended for evaluating treatment response in solid tumors by RECIST. This study aimed to elucidate the prognostic implication of the maximum short-axis diameter of lymph node (cN-size) before preoperative chemotherapy for ESCC. Methods We enrolled a total of 152 patients who underwent preoperative cisplatin/5-fluorouracil therapy (CF) followed by esophagectomy from 2005 to 2011. There were 127 men and 25 women with a median age of 65 years (range: 47–79 years). Clinically metastatic node was defined as follows; the node with cN-size ≥10 mm or that with 5 mm ≤ cN-size Results The number of patients with cN0 and cN1–3 was 60 and 92, respectively. Twenty-seven and 65 patients with cN1–3 were classified into cN-size Conclusion The maximum short-axis diameter of lymph node before preoperative chemotherapy is significantly associated with OS in patients with ESCC. Lymph node with 5 mm ≤ cN-size

The purpose of this study was to examine whether vehicle type based on size (car vs. other = truck/van/SUV) had an impact on the speeding, acceleration, and braking patterns of older male and female drivers (70 years and older) from a Canadian longitudinal study. The primary hypothesis was that older adults driving larger vehicles (e.g., trucks, SUVs, or vans) would be more likely to speed than those driving cars. Participants (n = 493) had a device installed in their vehicles that recorded their everyday driving. The findings suggest that the type of vehicle driven had little or no impact on per cent of time speeding or on the braking and accelerating patterns of older drivers. Given that the propensity for exceeding the speed limit was high among these older drivers, regardless of vehicle type, future research should examine what effect this behaviour has on older-driver road safety.

e13618Background: Approximately 5% of gastric cancer (GC) is associated with inherited cancer predisposition syndrome. Pathogenic germline BRCA1/2 mutations predispose, not only to breast and ovari...

A reddish depressed lesion was found in the corpus of the stomach of a 56-year-old man. Gastric biopsy showed no findings of mucosa-associated lymphoid tissue lymphoma, including lympho-epithelial lesions. A urea breath test, stool antigen test and serum IgG antibody to Helicobacter pylori test were negative. Magnifying endoscopy using narrow-band-imaging showed no malignant structures. Gastric biopsy specimens were subjected to immunohistochemistry and a polymerase chain reaction, which identified Helicobacter suis infection. Triple therapy with esomeprazole, metronidazole, and amoxicillin was administered for 10 days. Three months later, endoscopy showed the significant improvement of the lesion. H. suis infection should be considered in chronic gastritis patients without H. pylori infection.

Surgery is the standard of care for T1bN0M0 esophageal squamous cell carcinoma (ESCC), whereas chemoradiotherapy (CRT) is a treatment option. This trial aimed to investigate the noninferiority of CRT relative to surgery for T1bN0M0 ESCC.Clinical T1bN0M0 ESCC patients were eligible for enrollment in this prospective nonrandomized controlled study of surgery versus CRT. The primary endpoint was overall survival, which was determined using inverse probability weighting with propensity scoring. Surgery consisted of an esophagectomy with 2- or 3-field lymph node dissection. CRT consisted of 2 courses of 5-fluorouracil (700 mg/mFrom December 20, 2006 to February 5, 2013, a total of 368 patients were enrolled in the nonrandomized portion of the study. The patient characteristics in surgery arm and CRT arm, respectively, were as follows: median age, 62 and 65 years; proportion of males, 82.8% and 88.1%; and proportion of performance status 0, 99.5% and 98.1%. Comparisons were made using the nonrandomized groups. The 5-year overall survival rate was 86.5% in the surgery arm and 85.5% in the CRT arm (adjusted hazard ratio, 1.05; 95% confidence interval, 0.67-1.64 [1.78]). The complete response rate in the CRT arm was 87.3% (95% confidence interval, 81.1-92.1). The 5-year progression-free survival rate was 81.7% in the surgery arm and 71.6% in the CRT arm. Treatment-related deaths occurred in 2 patients in the surgery arm and none in the CRT arm.CRT is noninferior to surgery and should be considered for the treatment of T1bN0M0 ESCC.

Background Postoperative pulmonary complications (PPCs) are the most common causes of serious morbidity after esophagectomy, which involves both thoracic and abdominal incisions. Although the thoracoscopic approach decreases PPC frequency after esophagectomy, it remains unclear whether the frequency is further decreased by combining it with laparoscopic gastric mobilization. This study aimed to determine the impact of laparoscopy on the prevention of PPCs after thoracoscopic esophagectomy using data from the Japan Clinical Oncology Group Study 0502 (JCOG0502). Methods JCOG0502 is a four-arm prospective study comparing esophagectomy with definitive chemo-radiotherapy. The use of thoracoscopy and/or laparoscopy was decided at the surgeon’s discretion. PPCs were defined as one or more of the following postoperative morbidities grade ≥2 (as per Common Terminology Criteria for Adverse Events v3.0): pneumonia, atelectasis, and acute respiratory distress syndrome. Results A total of 379 patients were enrolled in JCOG0502. Of these, 210 patients underwent esophagectomy via thoracotomy with laparotomy (n = 102), thoracotomy with laparoscopy (n = 7), thoracoscopy with laparotomy (n = 43), and thoracoscopy with laparoscopy (n = 58). PPC frequency was reduced to a greater extent by thoracoscopy than by thoracotomy (thoracoscopy 15.8%, thoracotomy 30.3%; p = 0.015). However, following thoracoscopic esophagectomy, laparoscopy failed to further decrease the PPC frequency compared with laparotomy (laparoscopy 15.5%, laparotomy 16.3%; p = 1.00). Univariable analysis showed that thoracoscopy (shown above) and less blood loss (

Through their websites, universities establish global identities, enabling them to persuade potential students, partners, and research funders of their international prestige, relevance, and unique positioning to prepare students for competition in the global marketplace. They do so through forms of branding such as logos, slogans, images and texts intended to attract potential students, funders and partners. Addressing how website texts construct academic identities and reveal institutional aims, through critical discourse analysis, this paper examines textual discourses found on Canadian U15 Group of Universities’ websites. We focus specifically on how seemingly common-sense keywords are actually rich in ideological and socio-historical meaning. After identifying keywords and concepts across U15 websites, we determined that five themes dominated: University as a corporate entity, University as machine or vehicle, aspirational academic identities, market metaphors, and the doctrine of discovery. Noting the similarities in promotional discourses found across research-intensive university websites, we suggest that university websites communicate and foster neoliberal discourses, ideologies, values, and identities, thereby aligning universities with the values associated with consumer and petro-capitalism rather than with the traditional university ideals of intellectual pursuit, knowledge creation, disciplinary wisdom, good teaching and rigorous scholarship.

A reddish depressed lesion was found in the corpus of the stomach of a 56-year-old man. Gastric biopsy showed no findings of mucosa-associated lymphoid tissue lymphoma, including lympho-epithelial lesions. A urea breath test, stool antigen test and serum IgG antibody to Helicobacter pylori test were negative. Magnifying endoscopy using narrow-band-imaging showed no malignant structures. Gastric biopsy specimens were subjected to immunohistochemistry and a polymerase chain reaction, which identified Helicobacter suis infection. Triple therapy with esomeprazole, metronidazole, and amoxicillin was administered for 10 days. Three months later, endoscopy showed the significant improvement of the lesion. H. suis infection should be considered in chronic gastritis patients without H. pylori infection.

Introduction Precision medicine is only possible in oncology practice if targetable genes in fragmented DNA, such as DNA from formalin-fixed paraffin-embedded (FFPE) samples, can be sequenced using next generation sequencing (NGS). The aim of this study was to examine the quality and quantity of DNA from FFPE cancerous tissue samples from surgically resected and biopsy specimens. Methods DNA was extracted from unstained FFPE tissue sections prepared from surgically resected specimens of breast, colorectal and gastric cancer, and biopsy specimens of breast cancer. A total quantity of DNA ≥60 ng from a sample was considered adequate for NGS. The DNA quality was assessed by Q-ratios, with a Q-ratio >0.1 considered sufficient for NGS. Results The Q-ratio for DNA from FFPE tissue processed with neutral-buffered formalin was significantly better than that processed with unbuffered formalin. All Q-ratios for DNA from breast, colorectal and gastric cancer samples indicated DNA levels sufficient for NGS. DNA extracted from gastric cancer FFPE samples prepared within the last 7 years is suitable for NGS analysis, whereas those older than 7 years may not be suitable. Our data suggested that adequate amounts of DNA can be extracted from FFPE samples, not only of surgically resected tissue but also of biopsy specimens. Conclusions The type of formalin used for fixation and the time since FFPE sample preparation affect DNA quality. Sufficient amounts of DNA can be extracted from FFPE samples of both surgically resected and biopsy tissue, thus expanding the potential diagnostic uses of NGS in a clinical setting.

Background The 8th edition of the American Joint Committee on Cancer staging (AJCC-8th) of esophageal cancer presents independent stage grouping for patients who underwent neoadjuvant therapy followed by esophagectomy (ypTNM). The aim of this study is to elucidate the clinical utility of ypTNM stage grouping in Japanese patients with esophageal squamous cell carcinoma (ESCC). Methods A total of 146 patients (121 men and 25 women, with a median age of 65 years) who underwent curative esophagectomy following neoadjuvant chemotherapy with cisplatin and 5-fluorouracil (CF) for ESCC between 2005 and 2011 were enrolled in this retrospective study. We compared the distribution of patients and disease-specific survival after esophagectomy (DSS) stratified by ypStage between AJCC-7th and 8th. Additionally, we evaluated the association between clinicopathological features including ypStage in AJCC-8th and DSS. Results The number of patients classified into ypStage 0/IA/IB/IIA/IIB/IIIA/IIIB/IIIC/IV was 5/1/14/11/35/40/18/18/4 in AJCC-7th, and that classified into ypStage I/II/IIIA/IIIB/IVA/IVB was 27/18/21/58/18/4 in AJCC-8th. According to the revision from AJCC-7th to 8th, ypStage of 85 and 7 patients was up- and down-graded, respectively. Up-grading of ypStage was observed in 83% of patients with ypT4 tumor and in 78% of patients with ypN1–3. The 5-year DSS of ypStage 0/IA/IB/IIA/IIB/IIIA/IIIB/IIIC/IV was 100/100/93/91/75/62/50/28/50% in AJCC-7th, and that of ypStage I/II/IIIA/IIIB/IVA/IVB was 96/83/68/58/28/50% in AJCC-8th. The 5-year DSS of ypStage III was 61% in AJCC-8th comparing to 51% in AJCC-7th, and that of ypStage IV was 31% in AJCC-8th comparing to 50% in AJCC-7th. Univariate analyses identified ypT-8th (P = 0.028), ypN-8th (P Conclusion ypTNM stage grouping in AJCC-8th can more accurately stratify the prognosis of patients who underwent neoadjuvant CF therapy for ESCC, by classifying patients with residual tumor invasion to adjacent structures and regional lymph node metastasis into more unfavorable prognostic group than that in AJCC-7th. ypStage according to AJCC-8th is the most reliable prognosticator for this disease. Disclosure All authors have declared no conflicts of interest.

Background: The relationship between Helicobacter pylori infection and iron metabolism has not been well studied in Japan. We examined the association of H. pylori infection and its eradication to iron metabolism. Methods: A total of 654 adults who completed a health survey in 2012 were enrolled. H. pylori stool antigen was tested and serum antibody titer and serum iron, ferritin and pepsinogen levels were estimated. Subjects reported on their daily intake of the diets to calculate daily intake of iron and vitamin C. Among the H. pylori-infected patients surveyed in 2012, 177 patients completed the same health survey in 2014. For these patients, the change of daily intake of iron and vitamin C and serum iron and ferritin levels were examined. Results: In 2012, 244 subjects (37.3%) were considered as infected with H. pylori. In male subjects aged 35–64 years, serum level of ferritin was 77.5 (SD 53.1) ng/mL in infected patients and 130.6 (114.3) ng/mL in non-infected subjects (p

はじめに：大腸癌取扱い規約第7版（以下，第7版）では，腫瘍下縁がRSまたはRaの癌で3 cm，腫瘍下縁がRbの癌で2 cmの肛門側切離が必要であるとされている．直腸癌における肛門側癌進展（distal spread；以下，DS）に関する病理組織学的検討から直腸癌の肛門側切離範囲について検討した．方法：対象は直腸S状部癌および直腸癌213例．直腸間膜を含めた全割標本から，腸管壁内DSと直腸間膜内DSを検出し，それぞれの危険因子について検討した．また，第7版の定める肛門側切離範囲を超えるDSを高度DSとし，その特徴を明らかにした．結果：213例中31例（15％）にDSを認めた．内訳は，腸管壁内DSのみが20例，直腸間膜内DSのみが5例，腸管壁内DSと直腸間膜内DSの両者が6例であった．多変量解析では，腸管壁内DSの危険因子は組織型（tub2，por）と遠隔転移であり，直腸間膜内DSの危険因子は遠隔転移であった．高度DSは213例中3例（1.4％）に認め，全例がリンパ節転移を4個以上有するpN2症例であり，また3例中2例が遠隔転移を有していた．考察：遠隔転移を有する症例はDSを念頭においた手術が必要である．第7版の定める肛門側切離範囲は大部分の症例において妥当であるが，pN2症例や遠隔転移を有する症例の中には，高度DSを有する症例もあり，注意が必要である．

症例は60歳の男性で, 家族歴として, 一卵性双生児の兄が家族性大腸腺腫症で加療中である. 1974年, 家族性大腸腺腫症と診断され, 結腸全摘術, 回腸直腸吻合術を施行された. 1991年, 残存直腸の多発ポリープに対し残存直腸切除, 回腸. 肛門吻合術を施行された. 2000年, 多発胃癌に対し, 幽門側胃切除術を施行, 2002年, 残胃癌に対し内視鏡的粘膜切除術, 2006年, 局所切除術を施行された. 2007年3月, 上部消化管内視鏡検査で食道胃接合部直下に0-IIa病変を認め, また十二指腸に密生する多発ポリープを認めた. いずれも生検で高分化腺癌と診断された. 5月下旬, 胃局所切除術, 膵頭温存十二指腸全摘術を施行した. 病理組織学的診断は, 胃は高分化腺癌, 十二指腸は高分化腺癌および腺腫の混在する病変で, いずれも粘膜内癌であった. 術後, 縫合不全, 膵液瘻, 胆汁瘻などの合併症なく順調に経過し, 第11病日に退院した.

今回, 我々は極めてまれとされている残胃に発生した悪性リンパ腫と癌腫の衝突腫瘍症例を経験したので報告する. 症例は79歳の男性で, 67歳時に十二指腸悪性リンパ腫 (Non Hodgkin lymphoma, diffuse, small B cell type) にて幽門側胃切除術, Billroth II法再建を施行された. 2005年5月, 糖尿病の治療目的で入院した際の上部消化管内視鏡検査で残胃吻合部後壁に2型胃癌を指摘された. 2005年6月, 当科にて残胃全摘術, D1リンパ節郭清を施行された. 病理組織学的診断の結果, 悪性リンパ腫 (Non Hodgkin lymphoma, diffuse, small B cell type, 深達度fSM) と低分化腺癌 (深達度fMP) との衝突腫瘍と診断された. リンパ節転移は認めなかった. 術後, 肺炎および全身衰弱のため長期の入院加療を要した. 退院後は悪性リンパ腫, 癌腫ともに明らかな再発を認めずに経過したが, 術後2年目に重症肺炎にて死亡した.

Objective There is little information about the patterns of care for elderly esophageal squamous cell carcinoma patients, and a standardized strategy has not been established. Therefore, we conducted a questionnaire survey about the patterns of care for these patients. Methods On September 2014, the questionnaires were sent to all 43 institutions of the Japan Esophageal Oncology Group, which comprised five parts: (i) definition of 'elderly' (age, method), (ii) basic treatment strategy according to stage and elderly status (fit/vulnerable/frail), (iii) patterns of care in each stage, (iv) considerations about conducting future clinical trials and (v) other information about geriatric oncology concerning esophageal squamous cell carcinoma. Results All answers were obtained by January 2015. Nearly half institutions (47%) considered the chronological definition of elderly to be over 80 years old. Among 43 institutions, 36 (84%) reported that the type of comorbidity and performance status were important factors for decision-making; no institution selected geriatric scale as an indicator. The most selected treatment strategy in fit healthy elderly patients was the same as the standard treatment of non-elderly patients. Radiation alone was considered the main treatment for vulnerable and frail esophageal squamous cell carcinoma patients. Most of the institutions answered that clinical trials for the elderly are warranted. Most institutions (70%) chose Stage II/III (non-T4) esophageal squamous cell carcinoma as an important investigational target. Conclusions Fit healthy elderly were considered the same as non-elderly patients, although there are no established treatment selection criteria. Radiation alone plays most important role in the treatment for vulnerable and frail esophageal squamous cell carcinoma patients. Stage II/III (non-T4) disease is attractive and warranted for future investigations.

PURPOSE: NY-ESO-1, a member of the cancer/testis antigen (CTA) family, elicits humoral and cellular immune responses in patients with advanced cancer. Unresectable or metastatic esophageal carcinoma patients do not benefit from the present multimodality treatment regimens in terms of survival. The objectives of this study were to analyze the antibody response to NY-ESO-1 antigen in patients with esophageal cancer and to determine the potential of NY-ESO-1 for use in tumor-specific immunotherapy. METHODS: Serum from 69 patients with esophageal cancer was investigated for antibody production against NY-ESO-1 by Western blot analysis. Also analyzed by immunohistochemistry were 56 tissue samples from these patients for NY-ESO-1 protein expression. RESULTS: NY-ESO-1 protein expression was found in 18 of 56 (32%) esophageal carcinomas. Serum immunoreactivity specific for NY-ESO-1 was found in 9 patients (13%) of whom 8 were in the advanced stage (stages III and IV). There was no relationship between clinicopathologic features and serum immunoreactivity for NY-ESO-1. NY-ESO-1 protein expression was detected in three of five antibody-positive patients whose tissue was available for analysis. Survival analysis showed no significant difference between antibody-positive and antibody-negative patient groups. CONCLUSIONS: A humoral immune response to NY-ESO-1 antigen was established in patients with advanced esophageal cancer. NY-ESO-1 is a good candidate for vaccine-based immunotherapy for advanced esophageal carcinoma.

扁桃悪性リンパ腫の精査中に発見された早期胃癌と胃悪性リンパ腫の衝突腫瘍の1例を経験したので報告する. 症例は62歳の男性で, 2002年7月, 左扁桃腫脹を主訴に当院耳鼻咽喉科を受診し, 左扁桃悪性リンパ腫 (diffuse large B cell type) と診断された. 全身検索のために施行した上部消化管内視鏡検査にて胃体下部後壁に早期胃癌を発見され, 2002年9月10日, 当科にて幽門側胃切除, D2 リンパ節郭清を施行した. 病理診断の結果, 病変は高分化型腺癌 (深達度m) と悪性リンパ腫 (diffuse large B cell type, 深達度sm2) の衝突腫瘍を形成しており, リンパ節転移は認めなかった. 術後, 2002年10月18日より左扁桃悪性リンパ腫に対して, 当院関連病院内科にてCyclOBEAP療法を6コース施行し, 完全寛解を得た. 現在までに胃悪性リンパ腫, 胃癌および扁桃悪性リンパ腫の再発を認めていない.

Objective The Japanese health insurance system approved the use of proton pump inhibitors (PPIs) for the prevention of peptic ulcers in patients using low-dose aspirin (LDA) and/or non-steroidal anti-inflammatory drugs (NSAIDs). However, many orthopedists and physicians do not prescribe PPIs to elderly patients with atrophic gastritis. The aim of this study was to determine whether PPIs are effective in preventing gastrointestinal mucosal injury in elderly Japanese patients with atrophic gastritis. Methods We examined the associations between the use of antiulcer drugs and endoscopic findings in elderly Japanese patients using LDA or NSAIDs. Patients We evaluated 100 patients using LDA and 58 patients using non-aspirin NSAIDs 65 years of age or older. All patients underwent upper GI endoscopy to detect the presence of open ulcers and hemorrhagic lesions and assess the extent of atrophic gastritis. Results Among the patients using LDA, the prevalence of open ulcers was significantly lower in the patients using PPIs than in those using mucosal protective agent only and those not receiving antiulcer treatment (p

A case of superior mesenteric artery syndrome with gastric perforation in a 16-year-old woman is reported. The patient was admitted to the hospital because of abdominal pain and vomiting. Conservative therapy was started with a suspicion of superior mesenteric artery syndrome, but 2days later the abdominal pain was intensified. Emergency operation was performed with a diagnosis of generalized peritonitis. At laparotomy, gastric perforation associated with superior mesenteric syndrome was diagnosed. Partial gastrectomy and dissection of the Treitz' ligament were performed. The postoperative course was uneventful. Dissection of the Treitz' ligament that is minimal invasive is thought to be an appropriate procedure for patients with the disease in poor general condition.

To investigate the mechanisms of anti-tumor effects of chemotherapy and radiotherapy on esophageal carcinoma, apoptosis status was assessed by the TUNEL method in 14 esophageal carcinomas resected after preoperative chemotherapy with or without radiotherapy (Preoperative treatment group) and in 14 esophageal carcinomas primarily resected (Primary resection group). P 53 and Bcl-2 protein statuses were also as-sessed in both groups using immunohistochemical staining techniques. Apoptotic index expressed as a number of apoptotic cells per 1, 000 tumor cells was 15.5±3.3 and 8.6±1.8 in the preoperative treatment group and the primary resection group, respectively. There was no significant difference in apoptosis status between these two groups. However, the apoptotic index was significantly greater (p=0.04) in the tumors resected from responders of than that in the tumors resected from non-responders of the preoperative treatment. There was a significant correlation between p 53 and Bcl-2 labeling index (r=0.78, p=0.0017). In concision, the induction of apoptosis in obviously of paramount importance in enhancing the respose rate of the preopera-tive treatment.

CAAF1 and CAAF2, newly identified calcium-binding proteins from bovine amniotic fluid, have been revealed to be members of the S100 protein family preferentially produced by fetal squamous epithelial cells, including epidermal keratinocytes. Having previously cloned the cDNA of human CAAF1 protein from the esophageal epithelium, we report here on the characteristic expression pattern of CAAF1 and related S100 proteins in human esophageal epithelial cells. Normal cells of the human esophageal epithelium expressed CAAF1, and also expressed the homologous novel S100 proteins including CAAF2, MRP8, and MRP14, but not S100alpha. An immunohistochemical study with specific monoclonal antibodies against CAAF1 proteins demonstrated that CAAF1 proteins were produced by the esophageal epithelial cells in the process of cell differentiation. The immature proliferating cells in the epithelium did not produce CAAF1 proteins, but the differentiated cells expressed CAAF1, which overlay the immature cells and were stratifying in the epithelium. These CAA 1-producing cells did not show any proliferating activities. Esophageal carcinoma cells did not express CAAF1, except for the keratinized cells with no proliferating activity. In addition, the forced expression of CAAF1 proteins in the carcinoma cells resulted in a marked decrease in DNA synthesis. These findings indicate that human esophageal epithelial cells express the multiple genes of S100 proteins including CAAF proteins, and that CAAF1 is closely associated with the terminal differentiation of these cells. CAAF1 expression also might play some role in cell growth.

To elucidate the clinical characteristics of patients with elderyly-onset rheumatoid arthritis (EORA), we compared the clinical features, laboratory data, and clinical course of 17 patients with elderly-onset (age at onset; over 60 years, average 63.0 years with) 19 patients with younger-onset (below 50 years, average 38.3 years). The group with EORA had an increased incidence of hypertension, diabetes mellitus, cardiovascular disease, ischemic heart disease. There was no significant difference in the levels of ESR, CRP, IgG-RF titer, serum IgG concentration at entry, and the clinical course during two years follow-up between the 2 groups. In spite of EORA patients having a higher prevalence of complications to drugs including disease-modifying anti rheumatic drugs (DMARDs) and steroids, we considered that DMARDs (especially GST) and steroids must be used to prevent rapid bone destruction. In addition, surgical procedures including joint replacement were recommended to maintain the EORA patients activity of daily living.

Posterior lumbar interbody fusion is biomechanically a good procedure. Though recommended many years ago by Cloward, PLIF (posterior lumbar interbody fusion), was not widely used for many years. Recently, many authors have recognized PLIF as a preferred technique for lumbar stabilization. The use of this newfusion device provides immediate stabilization, preservation of discheight due to highly resistant material, and long term fusion with autogenous bone. Nine cases of posterior lumbar interbody fusion using this new fusion device were evaluated. Subjects included eight males and one female with a mean age of 49.3 years, ranging from twenty-four to seventy-four years. Diagnosis was degenerative spondylolisthesis in two cases, herniated disc disease in two, disc degeneration in three, degenerative lumbar scoliosis in two. Seven of nine cases achieved solid union, but union was delayed in three cases. If you select cases carefully, this implant is very useful because it acts as an interbody spacer with its own stabilizing capacity, without reguiring additional fixation.

Category: Midfoot/Forefoot Introduction/Purpose: Metatarsalgia of the lesser metatarsal heads are frequently associated with hallux valgus. The aim of this study was to evaluate how the relative length and the position of the first metatarsal head influences the prognosis of metatarsalgia and plantar callosities beneath the lessor metatarsal heads. Methods: A retrospective analysis of the clinical data and radiographs of 102 cases was performed at a mean follow-up period of 16 months after biplane interlocking osteotomies. Clinical evaluation was made using the Japanese Society for Surgery of the Foot (JSSF) hallux scale. Radiological evaluation was made with standard weight-bearing AP radiographs, and the hallux valgus angle (HVA), inter-metatarsal 1-2 angle (IMA), distal metatarsal articular angulation (DMAA), and the sesamoid position were evaluated. Relative first metatarsal length (RML) was determined according to Nilsonne/Morton’s technique. Results: The mean preoperative HVA decreased from 37 to 3 degrees, and the mean IMA from 17 to 4 degrees. The mean JSSF- hallux score improved from 56 to 96 points. The mean preoperative area of plantar callosities decreased from 3.1 to 1.5 mm2. Sixty percent of metatarsalgia improved, and 85% of painless callosities disappeared postoperatively. Among radiological parameters, postoperative RML was most significantly associated with JSSF score (P < .0001) and the presence of postoperative metatarsalgia (P < .0001). ROC analysis revealed that the RML cut-off point was -3 mm for avoiding metatarsalgia, with an area under the curve of 0.884, a specificity of 88%, and a sensitivity of 85%. Conclusion: Preservation of RML during first metatarsal osteotomy is important to prevent postoperative metatarsalgia.