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Herein we report on an extremely rare case of ulcerative colitis （UC） with onset after chemotherapy and colorectal resection, and discuss three previously reported cases. A 61-year-old man presented with fecal occult blood and no subjective symptoms. The diagnosis was rectal cancer with multiple liver metastases. Following chemotherapy, the patient underwent laparoscopy-assisted super-low anterior resection, liver resection. On Day 35 following closure of the ileostomy, the patient was referred to Totsuka Kyoritsu Dai-1 Hospital because of diarrhea, bloody stools. Colonoscopy and pathological examination revealed UC. To the best of our knowledge, only three cases of UC following colorectal cancer resection have been described previously. In conclusion, when encountering intractable diarrhea after chemotherapy or surgery, UC should be one of the bowel diseases considered, with prompt systemic examination recommended.

Controlling Nutritional Status (CONUT) is an efficient tool for early detection of malnutrition, measured using two biochemical parameters (serum albumin and total cholesterol) and one immune indicator (total lymphocyte count). The aim of this study was to define the efficacy of CONUT for predicting postoperative complications in very elderly patients with colorectal cancer. This study enrolled 52 patients aged 85 years or older with colorectal cancer for whom we were able to measure CONUT before surgery, conducted at the Department of Gastroenterological and General Surgery of Showa University Hospital in Japan between January 2010 and December 2014. The patients were subdivided into those with complications (Group C, n=9) and those with no complications (Group NC, n=43), and then were retrospectively compared for clinical characteristics, CONUT, and surgical outcomes. Multivariate analysis was finally performed to identify the risk factors of complications. The percentage of patients with a CONUT score of 5 or more in Group C was significantly greater than that in Group NC (7 vs. 12 patients, 77.8% vs. 27.9%, P=0.0079). No other significant difference was observed in the clinical characteristics between Group C and Group NC. Multivariate analysis identified CONUT score as the only significant predictor of complications in this patient cohort (odds ratio=1.374; 95% confidence interval, 1.019-1.949; P=0.0366). Our study suggests that CONUT score is predictive of postoperative complications in very elderly patients with colorectal cancer.

As data centers have become increasingly important in recent years their operational management must attain higher efficiency and reliability. Moreover, the power consumption of a data center is extremely large, and it is anticipated that it will continue to increase, so energy saving has become an urgent issue concerning data centers. In the meantime, the environment of the server rooms in data centers has become complicated owing to the introduction of virtualization technology, the installation of high-heat density information and communication technology (ICT) equipment and racks, and the diversification of cooling methods. It is very difficult to manage a server room in the case of such a complicated environment. When energy-saving measures are implemented in a server room with such a complicated environment, it is important to evaluate “temperature risks” in advance and calculate the energy-saving effect after the measures are taken. Under those circumstances, in this study, two prediction models are proposed: a model that predicts the rack intake temperature (so that the temperature risk can be evaluated in support of energy-saving measures implemented in the server room) and a model that evaluates the energy-saving effect (in relation to a baseline). Specifically, the models were constructed by using machine learning. The first constructed model evaluates the temperature risk in a verification room in advance, and it was confirmed that the model can evaluate the risk beforehand with high accuracy. The second constructed model—“baseline model” hereafter—supports energy-saving measures, and it was confirmed that the model can calculate the baseline (energy consumption) with high accuracy as well. Moreover, the effect of proposal process of energy-saving measures in the verification room was verified by using the two proposed models. In particular, the effectiveness of the model for evaluating temperature risk in advance and that of a technology for visualizing the energy-saving effect were confirmed.

Glutathione S-transferase (GST) is a major phase II drug-metabolizing enzyme. Several isoforms of human GST as well as different GST genetic polymorphisms are known, but limited data exists concerning the relationship between GST polymorphisms and GST activity using 1-chloro-2,4-dinitrobenzene in human liver. To resolve this query, we analyzed the genetic polymorphisms of four main GST isoforms [GST mu 1 (GSTM1), GST theta 1 (GSTT1), GST alpha 1 (GSTA1), GST pi 1 (GSTP1)] and measured hepatic GST activity isolated from the same patients. We found that GSTM1 null individuals have significantly lower (P=0.0082) GST activity compared with GSTM1 positive individuals. No significant changes in GST activity were observed in individuals with GSTT1, GSTA1, and GSTP1 genotypes. Interestingly, the levels of GST activity exhibited were similar when compared with GSTA1*A/*A and GSTA1*A/*B, and GSTP1*A/*A and GSTP1*A/*B, respectively, if the genotype was GSTM1 null. Therefore, the genotypes of GSTA1*A/*B and GSTP1*A/*B individuals do not significantly affect the level of hepatic GST activity. An examination of the correlation between GST mRNA expression and GST activity subsequently revealed a significant correlation between GSTM1 mRNA levels and GST activity (r=0.626, P=0.007). These data are expected to facilitate research on the prediction of efficacy and safety of GSTM1 null-mediated drug metabolism and may establish whether genetic polymorphisms of the GST gene, specifically GSTM1, can act as a biomarker.

Compared with the conventional open surgery, thoracoscopic esophagectomy results in decreased thorax destruction, fewer postoperative complications, and shorter hospitalisation. However, preoperative fasting causes hyperglycemia, prompting attempts to improve postoperative hyperglycemia by preoperatively administering carbohydrate orally or intravenously. Herein, we examined the effect of preoperative carbohydrate and amino acid infusion on counter-regulatory hormone levels in patients undergoing elective thoracoscopic esophagectomy. The glucose and amino acid (GA) group (n=12) were infused with a low concentration of sugar accelerant and amino acid, and the control (GAF) group (n=12) was infused with a sugar-free extracellular fluid, until entering the operating room. We evaluated plasma catecholamine 3 fractions, cortisol, and glucose, as well as 3-methylhistidine in the urine. Adrenaline levels were significantly higher in the GAF group (263.0±201.8µIU/ml) than in the GA group (114.7±127.0µIU/ml) at the end of the surgery (P=0.042), and at postoperative day (POD) 1 (200.8±137.4 vs. 80.5±64.3µIU/ml; P=0.013). The noradrenalin level was also significantly higher in the GAF group (517.9±523.6µIU/ml) than in the GA group (254.3±205.4µIU/ml) at POD1 (P=0.028), as was the cortisol level (20.0±10.6µIU/ml vs. 10.2±8.0µIU/ml; P=0.015). No significant differences were observed between the two groups in levels of blood glucose or 3-methylhistidine in the urine. Preoperative glucose-amino acid administration improved catabolism suppression in this study.

Esophagectomy for esophageal cancer is one of the most invasive gastrointestinal surgeries. In 1996, we introduced video-assisted thoracic surgery for esophageal cancer (VATS-E) to reduce surgical stress. In 2010, we started employing artificial pneumothorax (AP) using carbon dioxide gas in VATS-E to further reduce surgical stress. In this study, we evaluated interleukin-6 (IL-6) levels in pleural cavity lavage fluid (PLF) of patients undergoing VATS-E with or without AP, and examined the effect of AP on VATS-E-induced stress. This non-randomized study included patients who underwent VATS-E with or without AP at Showa University Hospital between 2009 and 2013 and from whom PLF could be collected. IL-6 concentrations in PLF were examined before and after the thoracic part of the operation. We compared IL-6 variation, defined as the difference between IL-6 concentrations in PLF before and after the thoracic part of the operation, between patients for whom AP was used and those for whom it was not used. A total of 52 patients were included in the study; 26 underwent VATS-E with AP (group AP), and 26 underwent VATS-E without AP (group NP). IL-6 concentrations in PLF were significantly elevated immediately after the thoracic part of the operation in both groups. IL-6 variation in PLF correlated with both thoracic operative time and blood loss, which were considered practical parameters of surgical stress, and was significantly lower in group AP than in group NP. In conclusion, IL-6 variation in PLF is a useful and sensitive maker of surgical stress during VATS-E. VATS-E with AP is less invasive than VATS-E without AP because AP lowers the perioperative systemic inflammatory response to thoracic surgery.

Maintaining a long transnasal ileus tube for a long period can be quite painful for patients such as in those with refractory intestinal obstruction and peritonitis carcinomatosa and it can markedly decrease quality of life (QOL) due to unexpected respiratory complications associated with the tube placement. To mitigate such complications, we undertook a trial insertion of a long ileus tube by gastrostomy in five patients with refractory intestinal obstruction (four cases of peritonitis carcinomatosa and one case of chronic intestinal pseudo-obstruction). We inserted the transgastric ileus tube using a percutaneous gastrostomy catheter kit after puncture with a plastic skin (PS) needle covered with a protective sheath, and then endoscopically placed the tube beyond the ligament of Treitz. Subsequently, we removed the long transnasal ileus tube, and comparable decompression was achieved. In all cases, the entire procedure was easily performed with no complications. Moreover, patients experienced reduced pain and stress and they were able to regain some freedom during activity.

To evaluate prognostic factors for recurrence after tegafur-uracil plus leucovorin (UFT/LV) adjuvant chemotherapy in patients with colorectal cancer (CRC). Consecutive patients with CRC who received UFT/LV as adjuvant chemotherapy at Showa University Hospital between June 2005 and December 2008 were included in the study, 5-year disease-free survival (DFS) and overall survival (OS) rates were estimated, and prognostic factors for recurrence were analyzed using the Cox proportional hazards model for multivariate analysis. Of 92 patients included in the study, 17 (18.5%) had disease recurrence. The 5-year DFS and OS rates were 82.2% and 91.9%, respectively. In the multivariate analysis, preoperative CA19-9 level＞37U/ml, emergency operation, and T4 lesions were independent significant prognostic factors after treatment with UFT/LV adjuvant chemotherapy. The three independent prognostic factors —T4 lesions, emergency operation, and high preoperative CA19-9 levels— may be useful for decision-making regarding whether patients should receive 5-fluouracil-based or L-oxaliplatin-based adjuvant chemotherapy. As this was a single-institution study with a small number of patients, our findings need to be confirmed in larger multicenter studies.