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This study investigates the prognosis of patients with postoperative atrial fibrillation (POAF), aiming to elucidate predictors of occurrence of atrial fibrillation (AF) in the chronic phase after esophagectomy.We retrospectively analyzed 415 consecutive patients between July 2010 and December 2021 who were scheduled to undergo esophagectomy for esophageal cancer and had no previous history of AF.POAF occurred in 73 patients (18%). Their ages were higher than those without POAF (72 [66-77] vs 68 [62-75], P 0.01). Three-field lymph node dissection was more frequent in patients with POAF (63% vs 50%, P = 0.04). Overall survival rates were not significantly different between those with and without POAF in patients with stage III/IV cancer (P = 0.37), but overall survival rate of patients with POAF was lower than in those without POAF in stage I/II cancer (P = 0.03). Seventeen patients (4.1%) had recurrence of AF or new onset 31 days after esophagectomy. POAF was the only independent predictor of AF development in the chronic phase (HR: 4.09, 95%CI: [1.42-11.74], P = 0.01). AF development in the chronic phase was observed in 8 patients (11.0%) with and 9 patients (2.6%) without POAF (P 0.01). AF development rates were not significantly different in patients with stage III/IV cancer (P = 0.05), but there was significant difference in patients with stage I/II cancer (P 0.01).The occurrence of POAF after esophagectomy is related with future development of AF and overall survival prognosis. Future studies must ascertain optimal therapeutic strategy.

非Down症児における急性巨核芽球性白血病 (AMKL) の発症は稀であり, 予後不良である. 症例は1歳4ヶ月の女児. 繰り返す発熱を主訴に他院にて治療されていたが, 末梢血中に芽球が出現したため, 香川大学医学部附属病院小児科に紹介入院となった. 血液検査の結果, 著明な白血球増多と貧血を呈しており, 芽球を2.0%認めたことから, 白血病の可能性を考慮し, 骨髄検査が行われた. 骨髄は高度過形成で芽球様細胞が78.8%認められた. 芽球様細胞は大小不同があり, 細胞質は好塩基性が強く, 辺縁はときにbleb様突起などの不整があり, ミエロペルオキシダーゼ (MPO) 染色は陰性であった. フローサイトメトリー (FCM) による細胞表面抗原はCD33, CD56, CD61, CD117陽性で, CD9, CD34, CD36, CD41, CD110などは陰性を示し, 細胞質内抗原ではTdT, CD3, CD79a, MPOがいずれも陰性であった. FCMの結果からAMKLの可能性を疑い, 細胞質内のCD41とCD61を追加で染色したところ共に陽性を示した. さらに染色体検査の結果が正常女性核型であったことから, 上記の所見と合わせて小児非Down症AMKL (non-DS-AMKL) と診断された. AMKLの巨核芽球は血小板関連抗原 (CD41, CD61, CD42b) のうち一つ以上が陽性を示すとされる. 本症例は形態的にAMKLの特徴を一部有し, 細胞表面のCD61が陽性でAMKLの条件を満たしたが, 非Down症児であることから, 芽球に付着した血小板による偽陽性の可能性を否定できず診断に苦慮した. しかし, 特異性が高いとされる細胞質内CD41, CD61の発現を証明できたことが確定診断をする上で根拠の一つとなり, FCMによる細胞内染色の重要性を再認識した症例であった. Acute megakaryoblastic leukemia (AMKL) in children without Down syndrome is rare and has a poor prognosis. A 16-month-old female, who was treated at another hospital with repeated fever, was referred to the Department of Pediatrics, Kagawa University Hospital, because of the appearance of blast cells in peripheral blood. A blood test showed marked leukocytosis and anemia, with 2.0% blast cells. Bone marrow was markedly hypercellular and 78.8% blast cells were observed. Blast cells were uneven in size, the cytoplasm was strongly basophilic, and the margins were sometimes irregular with bleb-like processes, and myeloperoxidase (MPO) staining was negative. Cell surface antigens by flow cytometry (FCM) were positive for CD33, CD56, CD61, and CD117, and negative for CD9, CD34, CD36, CD41, and CD110. The cytoplasmic antigens were negative for TdT, CD3, CD79a, and MPO. We suspected AMKL from FCM results, and when cytoplasmic CD41 and CD61 were additionally stained, both were positive. Furthermore, because the result of the chromosomal test showed a normal female karyotype, together with the above findings, a diagnosis of pediatric AMKL without Down syndrome (non-DS-AMKL) was made. AMKL megakaryoblasts are said to be positive for one or more of the platelet-related antigens (CD41, CD61, CD42b). This case had some morphological characteristics of AMKL, and the cells were positive for sCD61 which satisfied the conditions for AMKL. But because she was a non-Down syndrome child, the possibility of false positives due to platelets attached to blast cells could not be ruled out, making diagnosis difficult. However, the expression of cyCD41 and cyCD61, which are considered to be highly specific, was one of the criteria for making a definitive diagnosis. This case reaffirms the importance of intracellular staining by FCM.

Laparoscopic sleeve gastrectomy (LSG) for morbid obesity may improve gut microbiota balance and decrease chronic inflammation. This study examines the changes in gut microbiota and immune environment, including mucosal-associated invariant T cells (MAIT cells) and regulatory T cells (Treg cells) caused by LSG.Ten morbidly obese patients underwent LSG at our institution between December 2018 and March 2020. Flow cytometry for Th1/Th2/Th17 cells, Treg cells and MAIT cells in peripheral blood and colonic mucosa and 16S rRNA analysis of gut microbiota were performed preoperatively and then 12 months postoperatively.Twelve months after LSG, the median percent total weight loss was 30.3% and the median percent excess weight loss was 66.9%. According to laboratory data, adiponectin increased, leptin decreased, and chronic inflammation improved after LSG. In the gut microbiota, Bacteroidetes and Fusobacteria increased after LSG, and indices of alpha diversity increased after LSG. In colonic mucosa, the frequency of MAIT cells increased after LSG. In peripheral blood, the frequency of Th1 cells and effector Treg cells decreased after LSG.After LSG for morbid obesity, improvement in chronic inflammation in obesity is suggested by change in the constituent bacterial species, increase in the diversity of gut microbiota, increase in MAIT cells in the colonic mucosa, and decrease in effector Treg cells in the peripheral blood.

Postoperative adjuvant therapy for early gastric cancer (EGC) has not been widely studied, and there are differing indications for postoperative adjuvant therapy between Western and Asian countries. Japanese gastric cancer treatment guidelines do not recommend adjuvant chemotherapy for EGC, but it is unclear whether surgery alone is the most appropriate treatment.This is a single-center retrospective study of 1001 consecutive patients who underwent radical gastrectomy for pT1 gastric cancer between 1999 and 2013 at the Wakayama Medical University Hospital.Recurrence was observed in 12 patients, nine of whom as the result of hematogenous metastasis. In all patients with pT1 gastric cancer (n = 1001), lymph node metastasis was identified as an independent predictive factor for recurrence (hazard ratio [HR] = 10.910, P = 0.002). In patients with pT1N + gastric cancer, however, the 5-year disease-specific survival (DSS) rate was still high, 90.8%. In patients with pT1N + gastric cancer (n = 97), the presence of venous invasion (pT1N + v +) was identified by univariate and multivariate analyses as an independent risk factor for recurrence (HR = 4.791, P = 0.032). In patients with venous invasion, the 5-year DSS rate was significantly lower than that in those without venous invasion (79.3% vs. 95.2%, P = 0.018).Long-term prognosis of patients with EGC with lymph node metastasis is good, but venous invasion is associated with a higher risk of recurrence. Selective application of postoperative adjuvant chemotherapy for pT1N + v + gastric cancer may efficiently improve prognosis among patients with EGC.

Para-aortic lymph node (PAN) metastasis for gastric cancer is considered a distant lymph node metastasis. Meanwhile, multidisciplinary treatments have improved survival of patients with PAN metastases. We developed a novel technique of curative para-aortic lymph node dissection via infra-mesocolonic approach in laparoscopic gastrectomy (CAVING approach). This method minimizes the mobilization of the pancreas and the spleen and maximizes the view from the caudal side resembling cave exploration. After laparoscopic gastrectomy, PAN dissection is performed using the same ports setup. The retroperitoneum is widely exposed to ease anatomical cognition and for troubleshooting. The inferior vena cava, the left gonadal vein, the left renal vein, and the aorta are recognized under Gerota’s fascia. The retroperitoneum is then divided into four sections. We perform PAN dissection in the order of 16blat, 16b1int, 16a2lat, and then 16a2int. Using the CAVING approach, the caudal side of the root of the superior mesenteric artery can then be dissected below the pancreas, and only the cranial side of the SMA root requires a suprapancreatic approach. In three cases, preoperative chemotherapy and laparoscopic gastrectomy plus D2 with PAN dissection were performed for gastric cancer and esophagogastric junction cancer. The median operation totaled 484 min, 142 min for the PAN dissection. The median whole blood loss was 130 ml. The median harvested number of PAN was 25. The minimal mobilization of pancreas and the wide surgical fields by CAVING approach may facilitate safe and reliable PAN dissection.

Robotic subtotal gastrectomy (RsTG) with a small remnant stomach for treatment of gastric cancer (GC) in the upper stomach may have advantages over robotic TG (RTG). These may affect postoperative complications and postoperative nutritional status. This is a single-center retrospective study of 46 consecutive patients with GC who underwent RsTG (n = 10) and RTG (n = 36). The indication for RsTG included tumor located in the upper body of the stomach, in which the distance between the upper edge of the tumor and the junction was 2 cm or more and less than 5 cm, and no clinical evidence of lymph node metastasis. Operation time was significantly longer (384 min) and intraoperative blood loss was significantly larger (38 ml) in the RTG group than in the RsTG group (299.5 min, P = 0.021, and 25 ml P = 0.002). Two patients (5.6%) in the RTG group had complications, while no postoperative complications of higher than grade II were observed in the RsTG group. Serum albumin levels at 3 months after surgery were significantly higher in the RsTG group (3.85 g/dl) than in the RTG group (3.2 g/dl, P = 0.001). Postoperative recovery of bodyweight at 6 months after surgery was significantly better in the RsTG group (91.3%) than in the RTG group (84.25%, P = 0.001). RsTG for treatment of patients with GC in the upper body of the stomach is safe and feasible, and may enable improved postoperative nutritional status compared with RTG.

When compared with the second/third generation da Vinci S/Si, the fourth generation Xi surgical system may allow for greater efficiency and result in shorter operation times during robotic gastrectomy (RG) for gastric cancer (GC). We directly compare surgical outcomes between the conventional S/Si and the newer Xi robotic platform for the treatment of GC. This is a single-center retrospective study of 148 consecutive patients with GC who underwent RG. Of these patients, 20 patients were treated with the S, 30 patients with the Si, and 98 patients with the Xi. The overall operation time was significantly longer in the S group (386.5 min) than in the other groups (Si group: 292 min; Xi group: 297 min) (S vs. Si: P = 0.010; S vs. Xi: P = 0.001). We observed no difference, however, between the newer Xi and Si systems in operation time. Intraoperative blood loss was similar across the three groups. The overall postoperative complication rate in the Xi group (8.2%) was lower than that of the S group (10%) and the Si group (13.3%), but the difference was not significant. The newer Xi system did not provide significant intraoperative or early postoperative advantages over the Si system.

東北大学青葉山新キャンパスに現在建設中である次世代放射光施設には、軟X線及び硬X線ビームラインの両方が設置される。この施設では光学ハッチ外側、すなわち実験ホール全体を非管理区域と設定するため、蓄積リング周回電子と真空パイプ内残留ガスが相互作用して発生するガス制動放射線を十分に遮蔽できるようにビームライン遮蔽設計を行う必要がある。本講演では粒子輸送計算コードPHITSを用いた遮蔽設計の結果などを報告する。, 日本原子力学会 2022年春の大会

Introduction: Robotic surgery is regarded as an evolved type of laparoscopic surgery. Few studies have undertaken detailed analysis of complications following robotic gastrectomy for gastric cancer. Methods: This is a single-center retrospective study of 149 consecutive patients with gastric cancer who underwent robotic gastrectomy. It examines in detail the postoperative complications in robotic gastrectomy for gastric cancer, focusing on intra-abdominal infectious complications including anastomotic leakage, pancreatic fistula, and intra-abdominal abscess. We also aim to identify the related risk factors. Results: The median operation time was 299 min and the median bleeding was 25 mL. The incidence of overall complications higher than grade II was 8.7%. Clinically serious complications higher than grade IIIa occurred in 6.7% of cases. The incidence of intra-abdominal infectious complications that were higher than grade II was 4.0%. Mortality in our consecutive series was zero. Multivariate logistic regression analysis indicated that postoperative intra-abdominal infectious complications were significantly associated with history of abdominal surgery (p = 0.043), with odds ratios of 17.890 (95% confidence interval 1.092–293.150) and with non-curative resection (p = 0.025), with odds ratios of 58.629 (95% confidence interval 1.687–2,037.450). Discussion/Conclusion: Robotic gastrectomy was shown to be a safe and effective treatment for gastric cancer when performed by experienced surgeons. Attention should be paid to the risk of developing postoperative complications when performing robotic gastrectomy in gastric cancer patients with a history of abdominal surgery and in patients with advanced gastric cancer in whom there is expected to be difficulty in curative resection.

Background Administration of landiolol hydrochloride was found to be associated with reduced incidence of atrial fibrillation (AF) after esophagectomy for esophageal cancer in our previous randomized controlled trial (RCT). In addition, reduced incidence of AF was associated with reduction of other complications. Meanwhile, the effects of postoperative AF and other complications on long-term survival following esophagectomy are not well understood. Materials and methods Between March 2014 and January 2016, 100 patients with esophageal cancer were registered in an RCT trial and randomly allocated to receive either administration of landiolol or a placebo. We analyzed data from this RCT to better understand the effect of postoperative AF and severe associated complications on overall survival (OS) after esophagectomy for cancer. We also examined whether prophylactic administration of landiolol hydrochloride directly affects prolonged survival in patients with esophageal cancer. Results The five-year rates of OS in the patients with and without AF were 60%, and 68.6%, respectively, there was no significant difference (P = 0.328). Five-year rates of OS of the patients with and without severe complications were 64.6%, and 67.5%, respectively (P = 0.995). The five-year rates of OS in the placebo and landiolol groups were 65.8% and 68%, respectively (P = 0.809). In multivariate analysis, high stage (stage III/IV) alone was an independent prognostic factor for esophageal cancer patients following esophagectomy. Conclusions New-onset AF and the other severe complications were not associated with poorer long-term survival following esophagectomy. In addition, administration of landiolol hydrochloride after esophagectomy did not contribute to prolonging the OS.

Background This retrospective study aimed to investigate the short-term surgical outcomes and nutritional status of right colon interposition in patients with esophageal cancer who could not undergo gastric tube reconstruction. Methods 64 patients underwent subtotal esophagectomy with reconstruction using right colon interposition for esophageal cancer at Wakayama Medical University Hospital between January 2001 and July 2020. Results 18 patients had cologastrostomy and 46 patients had colojejunostomy. The median operation time in the cologastorostomy group was significantly shorter than that in the colojejunostomy group (494 minutes vs. 600 minutes; P = 0.0013). And, the median amount of blood loss in the cologastrostomy group was significantly less than that in the colojejunostomy group (209 ml vs. 485 ml; P = 0.037). The perforation of colon graft was observed in 3 patients (7%) and colon graft necrosis was observed in 1 patient (2%) were each observed in the gastrojejunostomy group. Median body weight change in one year after surgery in the cologastrostomy group was significantly less than that of the colojejunostomy group (93.6% vs. 86.8%; P = 0.041). Further, each of median serum total protein level and serum albumin level in one year after surgery in the cologastrostomy group was significantly higher than that of the colojejunostomy group (7.0g/dL vs. 6.5g/dL, P = 0.024, 3.9g/dL vs. 3.6g/dL, P = 0.045). Conclusions Subtotal esophagectomy with reconstruction using right colon interposition is a safe and feasible procedure for the patients with esophageal cancer in whom gastric tubes cannot be used. Cologastrostomy with preserving remnant stomach had benefits of the surgical outcomes and the postoperative nutritional status.

国内初の高輝度中型3GeV次世代放射光施設は2024年度から供用開始を目指して整備が進んでいる。次世代放射光施設では、「ユーザーが放射線業務従事者でなくても可能な限り放射光実験に参加できること」を基本方針として、加速器や放射光ビームラインから実験ホールへの漏洩線量を抑え、実験ホールを非管理区域にすることを目指している。供用開始前は到達真空度が低く、電子ビーム寿命が短くなることから、それらの条件下での線量評価及び蓄積リングトンネル内においてビーム損失に伴う二次中性子を検出することでビーム損失のモニタリングを行う手法について報告する。, 第36回 研究会「放射線検出器とその応用」

A compact 3 GeV light source is currently constructed at Aoba campus of Tohoku university in Miyagi prefecture, in which both soft and hard x-rays are to be available. In this facility, an area outside of optical hatch is set to a non-restricted area. For that purpose, gas bremsstrahlung radiation that is generated by interacting electrons with residual gas in the beam pipe must be shielded. On the other hand, the design of the beam dump of 3 GeV electron at LINAC is also designed. We present shielding design for optical hatch and LINAC beam dump by using PHITS code., 2021 Symposium on Nuclear Data

Significant efficacy of induced pluripotent stem cells (iPSCs) in generating DCs for cancer vaccine therapy was suggested in our previous studies. In clinical application of DC vaccine therapy, however, few DC vaccine systems have shown strong clinical response. To enhance immunogenicity in the DC vaccine, we transfected patient-derived iPSDCs with in vitro transcriptional RNA (ivtRNA), which was obtained from tumors of three patients with colorectal cancer.We investigated iPSDCs-ivtRNA which were induced by transfecting ivtRNA obtained from tumors of three colorectal cancer patients, and examined its antitumor effect. Moreover, we analyzed neoantigens expressed in colorectal cancer cells and examined whether iPSDCs-ivtRNA induced cytotoxic T lymphocytes (CTLs) against the predicted neoantigens.CTLs activated by iPSDCs-ivtRNA exhibited cytotoxic activity against the tumor spheroids in all three patients with colorectal cancer. Whole-exome sequencing revealed 1251 nonsynonymous mutations and 2155 neoantigens (IC50 In vitro CTLs obtained by transfecting tumor-derived RNA into iPSDCs derived from three patients with colorectal cancer showed potent tumor-specific killing effect.

3GeV次世代放射光施設では、「ユーザーが放射線従事者でなくても可能な限り放射光実験に参加できること」を基本方針として、これを実現するためにビームライン光学ハッチから実験ホールへの漏洩線量が十分に低くなるように遮蔽設計を行い、実験ホールを非管理区域にすることを目指す。現在、初期に整備される10本の放射光ビームラインの遮蔽設計、施設全体の線量評価を進めており、遮蔽設計の進捗等について報告する。, 第82回応用物理学会秋季学術講演会

Importance Robotic gastrectomy (RG) for gastric cancer may be associated with decreased incidence of intra-abdominal infectious complications, including pancreatic fistula, leakage, and abscess. Prospective randomized clinical trials comparing laparoscopic gastrectomy (LG) and RG are thus required. Objective To compare the short-term surgical outcomes of RG with those of LG for patients with gastric cancer. Design, Setting, and Participants In this phase 3, prospective superiority randomized clinical trial of RG vs LG regarding reduction of complications, 241 patients with resectable gastric cancer (clinical stages I-III) were enrolled between April 1, 2018, and October 31, 2020. Interventions LG vs RG. Main Outcomes and Measures The primary end point was the incidence of postoperative intra-abdominal infectious complications. Secondary end points were incidence of any complications, surgical results, postoperative courses, and oncologic outcomes. The modified intention-to-treat population excluded patients who had been randomized and met the postrandomization exclusion criteria. There was also a per-protocol population for analysis of postoperative complications. Results This study enrolled 241 patients, with 236 patients in the modified intention-to-treat population (150 men [63.6%]; mean [SD] age, 70.8 [10.7] years). There was no significant difference in the incidence of intra-abdominal infectious complications (per-protocol population: 10 of 117 [8.5%] in the LG group vs 7 of 113 [6.2%] in the RG group). Of 241 patients, 122 were randomly assigned to the LG group, and 119 patients were randomly assigned to the RG group. Two of the 122 patients (1.6%) in the LG group converted from LG to open surgery, and 4 of 119 patients (3.4%) in the RG group converted from RG to open or laparoscopic surgery, with no significant difference. Finally, 117 patients in the LG group completed the procedure, and 113 in the RG group completed the procedure; these populations were defined as the per-protocol population. The overall incidence of postoperative complications of grade II or higher was significantly higher in the LG group (23 [19.7%]) than in the RG group (10 [8.8%]) (P = .02). Even in analysis limited to grade IIIa or higher, the complication rate was still significantly higher in the LG group (19 [16.2%]) than in the RG group (6 [5.3%]) (P = .01). Conclusions and Relevance This study found no reduction of intra-abdominal infectious complications with RG compared with LG for gastric cancer. Trial Registration umin.ac.jp/ctr Identifier:UMIN000031536

This study aimed to clarify the characteristics and treatment of bowel obstruction associated with feeding jejunostomy in patients who underwent esophagectomy for esophageal cancer. In this single-center retrospective study, 363 patients underwent esophagectomy with mediastinal lymph node dissection for esophageal cancer at the Wakayama Medical University Hospital between January 2014 and June 2021. All patients who underwent esophagectomy routinely underwent feeding jejunostomy or gastrostomy. Feeding jejunostomy was used in the cases of gastric tube reconstruction through the posterior mediastinal route or colon reconstruction, while feeding gastrostomy was used in cases of retrosternal route gastric tube reconstruction. Nasogastric feeding tubes and round ligament technique were not used. Postoperative small bowel obstruction occurred in 19 of 197 cases of posterior mediastinal route reconstruction (9.6%), but in no cases of retrosternal route reconstruction because of the feeding gastrostomy (P .0001). Of the 19 patients who had bowel obstruction after feeding jejunostomy, 10 patients underwent reoperation (53%) and the remaining 9 patients had conservative treatment (47%). The cumulative incidence of bowel obstruction after feeding jejunostomy was 6.7% at 1 year and 8.7% at 2 years. Feeding jejunostomy following esophagectomy is a risk factor for small bowel obstruction. We recommend feeding gastrostomy inserted from the antrum to the jejunum in the cases of gastric tube reconstruction through the retrosternal route or nasogastric feeding tube in the cases of reconstruction through the posterior mediastinal route.

Background: Myelodysplastic syndromes (MDS) and idiopathic cytopenia of undetermined significance (ICUS) are heterogeneous hematological disorders characterized by hematopoietic dysplasia and/or chromosomal aberrancy. Objectives: This study aimed to evaluate the diagnostic value of flow cytometry standardized using the European LeukemiaNet (ELN) for MDS and ICUS by analyzing samples obtained from patients with cytopenia based on morphological examination, cytogenetic analysis, and flow cytometry. Methods: We retrospectively analyzed bone marrow samples aspirated from 253 consecutive patients (median age: 66 years [range: 1–92]) to identify the cause of cytopenia. Results: Sixty patients presented with MDS, and 16 with ICUS. MDS subtypes were distributed as follows: MDS with single-lineage dysplasia (n = 10); MDS with multi-lineage dysplasia (n = 10); MDS with ringed sideroblasts (n = 4); MDS with excess blasts-1 (n = 9); MDS with excess blasts-2 (n = 13), MDS unclassified (n = 5); 5q-syndrome (n = 6); and MDS/myeloproliferative neoplasms (n = 3). Four representative ELN indexes were used. Two or more ELN MDS indexes were in the abnormal range in 35 MDS cases (58.3%) and 4 ICUS cases (25.0%). Conclusions: Morphological examination remains the standard for MDS diagnosis. Considering the low incidence of genetically proven ICUS (20.2–27.5%), the low sensitivity of ELN MDS indexes for ICUS is considered a valuable alternative.

Purpose We investigated that double-tract reconstruction (DTR) may be more beneficial than esophagogastrostomy (EG) with fundoplication in terms of nutritional outcomes, focusing on loss of body weight. Materials and methods This study included 56 consecutive patients with early gastric cancer in the upper third of the stomach who received laparoscopic proximal gastrectomy, 39 underwent EG. In the 17 patients requiring resection of the abdominal esophagus or where the size of the remnant stomach was 50% or less, we performed DTR. Results There was no significant difference in the rate of body weight change at 6 or 12 months, or in biochemical markers (hemoglobin, total protein, and albumin) at 12 months. However, 8 patients in the EG group had extreme body weight loss (≥20%) within 12 months. Conversely, in the DTR group, no patients had any extreme body weight loss. Conclusion DTR is useful after laparoscopic proximal gastrectomy, especially in terms of preventing extreme body weight loss.

We aimed to compare oral and pathogenic microorganisms in bloodstream infections (BSIs) in allogeneic hematopoietic stem cell transplantation (allo-HSCT). We also investigated the relationship between BSIs and oral mucositis to identify the ratio of BSIs caused by oral microorganisms and the pathogenic microorganisms involved. We collected data on BSIs in 96 patients who underwent allo-HSCT in our institute between April 2009 and December 2019, including BSI pathogens isolated from blood cultures (BBSIs) and microorganisms isolated from washing the oral cavity with sterile distilled water. Oral microorganisms obtained at the onset of BSI (OBSIs) and during allo-HSCT (OSCTs) were defined as isolates collected during the week of blood culturing. Study entry was limited to samples collected up to 1 month after allo-HSCT without BSI. When the BBSI and OBSI were the same, we considered the oral microorganism to have caused the BSI. The incidence rate of BSIs was 27%, and the predominant microorganism was coagulase-negative Staphylococci. Normal bacterial flora were decreased to 15.8% in OBSIs and 25.5% in OSCTs. The distribution of microorganisms without normal bacterial flora showed significant difference between BBSIs and OSCTs (p

The usefulness, safety and oncological validity of laparoscopic gastrectomy (LG) for remnant gastric cancer (RGC) have not been widely reported. A total of 38 patients who underwent gastrectomy for RGC were enrolled at Wakayama Medical University Hospital between April 2008 and December 2018. All consecutive patients were included in this retrospective study; the patients were divided into the open gastrectomy group and the laparoscopic group according to the sequential nature of their operation. Fifteen patients underwent open gastrectomy for RGC (OGR) between April 2008 and December 2013, and 23 patients underwent LG for RGC (LGR) after 2014. In the OGR group, all initial operations were performed by open surgery, whereas in the LGR group, 11 patients (47%) initially underwent laparoscopic surgery and 12 patients (53%) initially underwent open surgery (P = .002), 3 patients of which (25%) converted to open gastrectomy. There was no significant difference in the number of lymph node dissections or in operative time between the 2 groups, but blood loss was significantly lower in the LGR group than that in the OGR group (P = .002). Furthermore, although there was no difference between the 2 groups in C-reactive protein value on postoperative day 1, C-reactive protein value on postoperative day 3 was significantly lower in the LGR group than in the OGR group (P = .012). There were no differences in postoperative complications or long-term outcomes, including recurrence-free survival and overall survival. LGy is suitable in cases in which the initial surgery is performed by laparoscopic surgery. Even if the initial surgery is open surgery, it is oncologically equivalent to open gastrectomy and can be performed safely with less blood loss.

Laparoscopic surgery may be a suitable treatment for gastrointestinal stromal tumors (GISTs) in terms of oncological feasibility and being minimally invasive. Case series of laparoscopic resection for duodenal GISTs have not been reported in detail, so in this report, the detail of laparoscopic surgeries for duodenal GISTs is summarized. This is a single-center retrospective case series of six consecutive patients with duodenal GISTs who underwent laparoscopic limited resection of the duodenum between 2003 and 2019. Tumors were located within the first portion in three patients, the second portion in two patients, and the third portion in one patient. Median tumor size was 25 mm. Four patients underwent a laparoscopic and endoscopic full-thickness resection with primary closure, one patient underwent a laparoscopic wedge resection, and one patient underwent a laparoscopic segmental duodenectomy with Roux-en-Y gastrojejunostomy. Median blood loss was minimal (10 ml) with median operative time of 2 h, and there were no conversions to open surgery. There were no intraoperative or postoperative complications. All patients underwent curative resection with negative surgical margins, and none had recurrence of their duodenal GISTs. All patients were alive at the end of the follow-up period of 54 months. Laparoscopic limited resection is a feasible, safe, and ideal treatment procedure for duodenal GISTs in terms of short- and long-term surgical outcomes.

Background Carcinoembryonic antigen-related cell adhesion molecule 1 (CEACAM1) is re-expressed at the invasion front of colorectal cancer. CEACAM1 expression at metastatic sites remains to be investigated. The current study aims to clarify the association between CEACAM1 expression and recurrence after hepatectomy of colorectal liver metastasis and to address whether CEACAM1 induces tumor-initiating properties needed for growth at metastatic sites. Methods Immunohistochemical analyses for CEACAM1 were performed in 67 patients with liver metastasis of colorectal cancer who had undergone curative hepatectomy. The risk factors for postoperative recurrence were calculated based on a CEACAM1 cytoplasmic domain isoform at the primary tumor invasion front. To investigate the effects of CEACAM1 cytoplasmic isoforms on HT29 and HCT116 colorectal cancer cells, Western blotting for CD44 and CD133, flow cytometry for ALDH1 activity, and soft-agar colony formation assay were performed. Results CEACAM1 long (CEACAM1-L) and short (CEACAM1-S) cytoplasmic domain isoforms are strongly expressed on cancer cells in the liver metastases. Enhanced CEACAM1-S expression in the state of CEACAM1-L dominance at the primary tumor invasion front was an independent factor for colorectal cancer recurrence after curative hepatectomy. CEACAM1-4S-transfected HT29 and HCT116 cells had significantly higher CD44 expression and ALDH1 activity and increased the growth in anchorage-independent condition. Conclusions High expression of CEACAM1-S at the primary lesion invasion front is associated with recurrence and prognosis of patients with colorectal liver metastasis after curative hepatectomy. The expression of CEACAM1-4S enhances the tumor-initiating property of colorectal cancer cells.