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Owing to their rarity, pancreatic metastases from thyroid cancers have not been fully elucidated.Observational studies written in English between 1990 and 2020 were included in this review.The median duration from thyroidectomy to the diagnosis of pancreatic metastases was 105 months. Twenty-five patients underwent surgery, including pancreatoduodenectomy in 10, distal pancreatectomy in 10, enucleation in 4, and total pancreatectomy in 1. The remaining 5 patients did not undergo surgery. Twenty-one patients survived and 9 died, with a median overall survival of 61 months. The overall 5-year survival rate after diagnosis was 58.7%. Of these patients, the overall 5-year survival rate was 63.4% in patients who underwent surgery (surgery group, n = 21), while 2 patients were censored during follow-up, and one patient died 20 months after diagnosis (non-operative group, n = 3) (p = 0.567). Of these patients, the overall 5-year survival rate was 85.7% in patients with curative resection and 53.6% in patients with noncurative resection.Patients with pancreatic metastases from thyroid cancer had good prognosis, if curative resection can be performed.

A hydrophobic surface or coating is required for surface protection, anti-fouling, adhesion, and other applications. For the achievements of hydrophobic properties, fluorine-based coatings, such as the introduction of trifluoromethyl or difluoromethylene groups, are conventionally employed. Recent developments in synthetic chemistry have indicated other organic fluoroalkyl groups that are suitable for achieving a more hydrophobic surface. In this study, we focused on the hydrophobic properties of the pentafluorosulfanyl (−SF₅) group. We synthesized polymethacrylates with −SF₅ groups or other functional groups (−CF₃, −CH₃, and −H) in their side chains and evaluated their hydrophobicity based on contact angles of water and ethylene glycol and the affinities of their films to water through neutron reflectivity measurements to demonstrate the superior hydrophobic properties of the −SF₅ group. The water contact angle on the polymethacrylate film with −SF₅ groups was larger, which suggested that the surface free energy was lower than that of the other polymethacrylate thin films with pendant side chains of −CF₃, −CH₃, and −H. In addition, the fitting analyses of the neutron reflectivity profiles of the thin polymer films in contact with air and water revealed the lowest affinity between water and the surface of polymethacrylate films with −SF₅ groups among the films of the synthesized polymers. Thus, we demonstrated the potential of pentafluorosulfanyl groups as advanced hydrophobic groups.

In the 2016 update of the World Health Organization (WHO) classification of myeloid neoplasms, acute undifferentiated leukemia (AUL) was defined by a lack of lineage-specific markers. AUL has very poor prognosis and no established therapies due to its rarity. We report a case of a 31-year-old man with AUL who showed complete molecular response to an acute lymphoblastic leukemia (ALL)-based regimen and received allogeneic hematopoietic stem cell transplantation. The patient's blast cells were CD7-positive and localized to lymph nodes in the neck and to a large mediastinal mass; there was also rearrangement of the T-cell receptor delta locus. Although the tumor showed characteristics of T-cell lymphoblastic lymphoma, it was categorized as AUL based on WHO classification. This case suggests that a high-intensity conditioning regimen could be effective for rare cases of AUL that present only in the extramedullary mass, and chemotherapy for AUL should be selected based on the characteristics of the blasts.

Background Primary squamous cell carcinoma (SCC) of stomach is extremely rare. The pathogenesis of SCC of stomach remains unclear. There is only one report that Epstein Barr virus (EBV) infection may be involved in the pathogenesis of SCC arising in the stomach ever before. Here, we report a case of Epstein Barr virus infection-associated primary SCC of stomach in a 70-year-old woman. She was presented to the referring hospital with hematemesis. Initial endoscopy revealed a bleeding gastric ulcer in the upper part of gastric corpus and the coagulation therapy was followed. After a 3-month follow-up, endoscopy revealed a submucosal tumor-like protrusion instead of an ulcer. Computed tomography revealed a mass in the upper part of stomach and swollen lymph nodes along with the lesser curvature and para-aortic lymph node. Biopsy could not confirm the definitive diagnosis. We performed total gastrectomy with para-aortic lymph node sampling. Histological analysis revealed squamous cell carcinoma with EBV infection with lymph node metastases. Tumor cells were positive for EBV-encoded small RNA (EBER) by in situ hybridization. The postoperative course was uneventful and the patient was discharged on day 11 after the operation. CapeOX was started as adjuvant chemotherapy, and the patient remains alive without recurrence 7 months after surgery. Conclusion This is the first case report of EBV infection-associated primary SCC of the stomach diagnosed by in situ hybridization of EBER. EBV infection may be related to the pathogenesis of primary SCC. Further evidence and studies are required to establish optimal strategy for this rare disease.

Background It is unclear which body composition affects postoperative pancreatic fistula (POPF) after pancreaticoduodenectomy. In the present study, we evaluated the relationship between nutritional factors, body composition, and POPF. Methods This was a prospective observational cohort study. Patients who underwent pancreaticoduodenectomy between March 2018 and July 2021 were included in this study. Preoperative body composition was measured using a bioelectrical impedance analyzer. In addition, the predictive factors for POPF were analyzed. Results The study included 143 patients. Among these patients, 31 had POPF (POPF group) and 112 did not (non-POPF group) after pancreaticoduodenectomy. For body composition, the percent body fat was significantly higher in the POPF group (26.90 vs 23.48, P = 0.022). Multivariate analysis revealed that alcohol consumption (odds ratio 2.71, P = 0.028), body mass index ≥ 25.0 kg/m2 (odds ratio 3.43, P = 0.01), albumin level (odds ratio 2.65, P = 0.028), and percent body fat (odds ratio 1.06, P = 0.032) were significantly independent predictive factors for POPF. When the patients were divided into three groups based on their percent body fat (P = 0.008). Conclusion Pancreaticoduodenectomy could be performed if it is technically and oncologically appropriate, and predictive factors for POPF, such as percent body fat, should be considered before proceeding to surgery (ClinicalTrials.gov trial registration no. NCT5257434).

A 67-year-old woman underwent polypectomy for a tumor at the descending colon. Pathologically, the tumor was diagnosed as adenocarcinoma with an invasion of 2000 μm. Computed tomography showed a swollen paracolic lymph node and a mass lesion in the presacral space. Magnetic resonance imaging revealed a multio-cular cystic lesion. On diagnosis of descending colon cancer and tailgut cyst, she underwent synchronous lapa-roscopic resection. Histopathologically, the colon cancer was diagnosed as pT1bN1M0, pStage IIIa. The pre-sacral cystic lesion was diagnosed as a nonmalignant tailgut cyst with negative surgical margin. The patient is currently doing well without recurrence at 28 months.

Aims The safety and efficacy of pancreaticoduodenectomy (PD) in patients over the age of 80 years remain controversial. We aimed to examine post‐PD outcomes and to determine the age limit for PD. Methods Patients were divided into two subgroups: the younger (, The safety and efficacy of pancreaticoduodenectomy (PD) in patients over the age of 80 years remain controversial. Although our findings showed that the general preoperative condition and nutritional status were significantly worse in the octogenarian group, there were no significant differences between both groups regarding postoperative severe complication rates or perioperative mortality rates. The instrumental activities of daily living (IADL) scale in octogenarian patients might be preserved enough high functioning, although IADL scale in the octogenarian group was significantly lower than that in the younger group. The 3‐, 5‐, and 10‐year overall survival were significantly worse in the younger group than in the octogenarian group. In the younger group, the main cause of death (89.6%) was cancer recurrence. However, only 60% of patients in the octogenarian group developed and died from cancer recurrence.

Trousseau’s syndrome (TS) and tumor thrombosis (TT) are known as cancer-associated thrombosis with poor prognosis. TS is extremely rare in patients with squamous cell carcinoma. In this study, we report an unknown primary squamous cell carcinoma of the head and neck (SCCHN) patient with TS and TT in pulmonary artery definitely diagnosed by autopsy. A 73-year-old man had a past surgical history for unknown primary SCCHN and lung metastases. Three years after the initial surgery, the patient had multiple cerebral infarction, deep venous thrombosis in the legs and mediastinum metastases. Our diagnosis was TS and treatment with chemotherapy and unfractionated molecular heparin started. It could help control the hypercoagulative state and cancer progression, but finally, he died from progressive disease (mediastinum metastases and pulmonary embolism) five years after the initial surgery. An autopsy revealed multiple metastases and thrombosis in the pulmonary artery with squamous cell carcinoma microscopically. Although there is no established treatment for managing TS, intensive therapy such as a combination of chemotherapy and anticoagulant therapy can be effective in improving hypercoagulation therapy. In addition, an autopsy should be considered for patients with thrombosis to distinguish between TS and TT.

Purpose The safety and feasibility of preserving the remnant stomach during distal pancreatectomy (DP) in patients who have undergone distal gastrectomy (DG) remains unclear. Methods A retrospective review of a prospectively maintained database was performed to identify patients who underwent DP. A propensity score-matched analysis was performed to match post-DG patients with control patients. Results Among the 226 patients included in this study, 9 DP patients who had a history of DG were studied (4.0%). These nine patients in the DG group were matched to 45 patients in the control group. There were no significant differences in the incidence of postoperative morbidities, including postoperative pancreatic fistula rate or stomach-related complications. The hemoglobin A1C (HbA1c) levels in the DG group after surgery decreased to the normal range. Conclusion Our study suggested that the remnant stomach may be safely preserved when performing DP in patients with a history of DG with respect to short-term morbidities. However, there are some concerns about the long-term nutritional status in patients with a history of DG.

Survival remains poor even after resection of pancreatic cancer and the postoperative recurrence rate is extremely high. Thus, neoadjuvant treatment may improve outcomes for resectable pancreatic cancer (RPC). This study evaluated the efficacy of neoadjuvant therapy for radiologically judged RPC. A prospectively maintained institutional database was reviewed to identify patients who underwent potentially curative resection of radiologically judged RPC. Patient characteristics and intermediate-term outcomes were compared between groups that received neoadjuvant treatment or upfront surgery (UFS). We identified 353 eligible patients, including 55 patients who received neoadjuvant chemoradiotherapy (CRT group), 53 patients who received neoadjuvant gemcitabine plus nab-paclitaxel (GnP group), and 245 patients who underwent UFS (UFS group). The cumulative rates of pancreatic cancer recurrence at 2 years after pancreatic surgery were 49.5% in the UFS, 48.1% in the CRT group, and 52.7% in the GnP group. The recurrence rate tended to be improved after neoadjuvant treatment, although the difference was not significant at this follow-up point. While the clinical TNM classifications were noticeably different from the final pathological findings, the clinical and pathological TNM classifications were more similar in the groups that underwent neoadjuvant treatment. Neoadjuvant treatment can help identify good surgical candidates and avoid unnecessary laparotomy. Our results also suggest that neoadjuvant therapy might help improve the preoperative diagnostic accuracy for patients with RPC.

Background and aims The effect of perioperative treatment with l-carnitine in hepatectomized patients is unclear. The objective of the current study is to evaluate the short-term outcomes after liver cancer surgery in patients treated with l-carnitine compared with nontreated patients. Methods Patients with primary liver malignancies scheduled to undergo a hepatectomy were randomly assigned to receive either perioperative treatment with l-carnitine (carnitine group) or usual intake (control group). The primary endpoint of this study was the short-term outcome after liver surgery. Results The study participants were randomly assigned into 2 groups: 106 patients in the control group and 102 patients in the perioperative l-carnitine supplementation group. The restoration of serum ammonia levels, prothrombin time, and peripheral neutrophil count at 3 days after the operation was significantly faster in the carnitine group than in the control group. Fewer patients in the carnitine group developed grade B posthepatic liver failure, according to the grading system of the International Study Group of Liver Surgery, than patients in the control group (20% vs 76%). The length of hospitalization was significantly shorter in patients in the carnitine group than in those in the control group. Conclusions We found that perioperative treatment with l-carnitine was significantly better than ordinary treatment in reducing postoperative serum ammonia levels, suggesting that l-carnitine may serve as a pivotal regulator of liver injury and repair and result in shorter postoperative hospitalization (ClinicalTrials.gov trial registration no. NCT03021876).

Feline embryo development was examined for 7 days after fertilization using commercially available human media supplemented with 0.3% bovine serum albumin (BSA) or 5% fetal bovine serum (FBS). Cumulus-oocyte complexes were categorized as Grades 1, 2, and 3 according to morphology. Only-One Medium (OM) was used for in vitro culture (IVC) in OM + BSA, OM + FBS, and OM + BSA/FBS, with BSA supplementation for the first 2 days and FBS for the subsequent 5 days. Embryos cultured in Early Culture Medium (1-2 days) and Blastocyst Medium (3-7 days) were defined as EB + BSA and EB + BSA/FBS. The developmental rate until the blastocyst stage of Grade 1 and 2 oocytes cultured in OM + BSA/FBS was higher than for the other groups and was significantly higher than for the OM + BSA and EB + BSA groups (P

We present the case of a Tailgut cyst occurring in the retrorectal space that was curatively resected using a posterior approach. A 40-year-old man presented to the Kochi Health Sciences Center with the chief complaint of perineal incongruity. Pelvic magnetic resonance imaging revealed a multilocular cystic lesion in the retrorectal space, with high signal intensity on T2-weighted imaging. After diagnosing a Tailgut cyst, we performed resection of the tumor using a posterior approach. The lesion was removed en bloc with the coccyx. Histopathologically, the lesion was diagnosed as a non-malignant Tailgut cyst, and the surgical margin was negative. The patient is currently doing well without recurrence at 20 months.

Cytochrome c oxidase (CcO) in the respiratory chain catalyzes oxygen reduction by coupling electron and proton transfer through the enzyme and proton pumping across the membrane. Although the functional unit of CcO is monomeric, mitochondrial CcO forms a monomer and a dimer, as well as a supercomplex with respiratory complexes I and III. A recent study showed that dimeric CcO has lower activity than monomeric CcO and proposed that dimeric CcO is a standby form for enzymatic activation in the mitochondrial membrane. Other studies have suggested that the dimerization is dependent on specifically arranged lipid molecules, peptide segments, and post-translationally modified amino acid residues. To re-examine the structural basis of dimerization, we improved the resolution of the crystallographic structure to 1.3 A by optimizing the method for cryoprotectant soaking. The observed electron density map revealed many weakly bound detergent and lipid molecules at the interface of the dimer. The dimer interface also contained hydrogen bonds with tightly bound cholate molecules, hydrophobic interactions between the transmembrane helices, and a Met–Met interaction between the extramembrane regions. These results imply that binding of physiological ligands structurally similar to cholate could trigger dimerization in the mitochondrial membrane and that non-specifically bound lipid molecules at the transmembrane surface between monomers support the stabilization of the dimer. The weak interactions involving the transmembrane helices and extramembrane regions may play a role in positioning each monomer at the correct orientation in the dimer.

We determined whether PODXL and SCGB1D2 expressions in whole blood could be useful as diagnostic biomarkers to determine the presence of intraductal papillary mucinous neoplasm (IPMN), as compared to serum CA19-9. A discovery-stage clinical study was performed on 12 patients with IPMN, including 6 intraductal papillary mucinous adenoma (IPMA) patients and 6 intraductal papillary mucinous carcinoma (IPMC) patients who had undergone treatment at the Department of Surgery at Kochi Health Sciences Center and the Department of Gastroenterology and Hepatology at Kochi Medical School Hospital from April 2015 to January 2016;13 controls who did not have pancreatic disease were also enrolled. Serum PODXL and SCGB1D2 levels were measured using ELISA. We found that the area under the receiver-operating characteristic curve (AUC) for IPMN (IPMA+IPMC) diagnosis in IPMN patients and control individuals was 0.89 (95% CI:0.76-1) for PODXL, 0.50 (95% CI:0.25-0.74) for SCGB1D2, and 0.81 (95% CI:0.62-1) for CA19-9. Multivariable logistic regression analysis showed that PODXL was independently able to distinguish IPMN patients from controls. PODXL may be a novel, non-invasive diagnostic biomarker for the detection of IPMN. The AUC for distinguishing IPMC patients from IPMA patients was 0.78 (95% CI:0.47-1) for PODXL, 0.83 (95% CI:0.58-1) for SCGB1D2, and 0.58 (95% CI:0.22-0.95) for CA19-9. Although it was quantitatively demonstrated that the detection of PODXL and SCGB1D2 in the serum may provide a novel, non-invasive approach for distinguishing IPMC patients from IPMA patients, the present findings are preliminary until more elaborate studies are able to clarify whether PODXL and SCGB1D2 are useful as diagnostic markers for IPMC detection.

The aim of this study was to validate and improve the 8th edition of the Union for International Cancer Control (UICC) staging system for pancreatic ductal adenocarcinoma (PDAC). Prognostic impact of the pathological tumor (pT) and lymph node (pN) stages between the 7th and 8th editions were compared using a single-center cohort of 311 patients who underwent curative pancreatic resection for PDAC. Applying the 7th edition T staging system resulted in a clustering of pT3 cases (92.3%) and failed to show significant prognostic differences between the three pT stages. However, applying the 8th edition T staging system yielded a more even distribution and resulted in an excellent prognostic separation between the pT stages based on decreases in median survival (month [pT1: 69.4, pT2: 27.6, pT3: 16.7], p=0.001). In pN staging system, the 8th edition provided more precise prognostication in median survival (month [pN0: 41.7, pN1: 25.6, pN2: 14.4], p

Since 2010, both universities in which the authors teach have integrated PC-based e-learning or mobile learning programs into several English courses. Students’ online performances are evaluated and used in determining the grades for each course. The data accumulated over the years indicates both changing and unchanged e-learning habits among Japanese university students. By analyzing the data, coupled with information obtained from questionnaires, we conclude that while some e-learning habits remain unchanged, several new learning habits have emerged. The unchanged e-learning habits include: predominant use of the iPhone, which remains the most popular mobile learning tool; a deadline rush for completing e-learning tasks; preference for evening and night for e-learning; e-learning diligence, i.e. the frequency of participation and duration of participation remain the same. The data also shows that in recent years some new trends have appeared in students’ e-learning: more students had experience with e-learning before entering university; fewer concerns about the cost of mobile phone Internet connection than previously.

The value of indocyanine green (ICG) test is negatively affected in patients with intrahepatic shunt, ICG excretory defect, or jaundice. This study evaluated 99mTc-GSA SPECT/CT fusion imaging for assessing liver function in patients with severely deteriorated ICG values. Thirteen hepatectomy candidates with ICG retention rates over 40% were retrospectively analyzed. The ICG clearance rate (KICG) and estimated KICG obtained by 99mTc-GSA scintigraphy (KGSA) were used to evaluate preoperative whole liver function. Remnant liver function was assessed using the remnant (rem) KICG (= KICG × volumetric rate) and remKGSA (= KGSA × functional rate) indices; hepatectomy was considered unsafe for values

The transcription factor Hes family basic helix-loop-helix transcription factor 1 (Hes1) is a downstream effector of Notch signaling and plays a crucial role in orchestrating developmental processes during the embryonic stage. However, its aberrant signaling in adulthood is linked to the pathogenesis of cancer. In the present study, we report the discovery of small organic molecules (JI051 and JI130) that impair the ability of Hes1 to repress transcription. Hes1 interacts with the transcriptional corepressor transducing-like enhancer of split 1 (TLE1) via an interaction domain comprising two tryptophan residues, prompting us to search a chemical library of 1,800 small molecules enriched for indole-like π-electron–rich pharmacophores for a compound that blocks Hes1-mediated transcriptional repression. This screening identified a lead compound whose extensive chemical modification to improve potency yielded JI051, which inhibited HEK293 cell proliferation with an EC50 of 0.3 μm. Unexpectedly, using immunomagnetic isolation and nanoscale LC-MS/MS, we found that JI051 does not bind TLE1 but instead interacts with prohibitin 2 (PHB2), a cancer-associated protein chaperone. We also found that JI051 stabilizes PHB2's interaction with Hes1 outside the nucleus, inducing G2/M cell-cycle arrest. Of note, JI051 dose-dependently reduced cell growth of the human pancreatic cancer cell line MIA PaCa-2, and JI130 treatment significantly reduced tumor volume in a murine pancreatic tumor xenograft model. These results suggest a previously unrecognized role for PHB2 in the regulation of Hes1 and may inform potential strategies for managing pancreatic cancer.

Preoperative methods to estimate disease-specific survival (DSS) for resectable pancreatic cancer are limited. The aim of this study was to develop and validate a pretreatment physiobiological prognostic model in patients with radiologically resectable pancreatic cancer. A retrospective review of a prospectively maintained institutional database was undertaken to identify patients who underwent potentially curative resection for radiologically resectable pancreatic cancer. Demographics, treatments, and relationships between the potential prognostic factors and survival rate were analyzed, and prognostic nomograms were established. We identified 240 patients who fulfilled our eligible criteria. The 1-, 3-, and 5-year DSS rates after surgery were 77.8, 40.9, and 31.3%, respectively. On multivariate analysis, increased neutrophil/lymphocyte ratio [hazard ratio (HR) 1.60, 95% confidence interval (CI) 1.17–2.17; p

The clinical and pathological diagnosis of desmoplastic melanoma is difficult, because almost 50% of desmoplastic melanoma cases involve non-pigmented lesions and the tumor cells can resemble fibroblasts or Schwannian cells based on their frequent amelanotic features. Moreover, desmoplastic melanoma typically has low positive rates for melanoma markers, with the exception of the S-100 protein. We report the case of an 81-year-old Japanese man with an 8-mm desmoplastic melanoma. He initially noticed a painless and non-pigmented skin lesion that did not grow noticeably for 6 months. It was unlikely that he had von Recklinghausen disease, and the mass was initially considered a dermatofibroma. Excisional biopsy revealed an intradermal mass, with the superficial portion mimicking neurofibroma and the deeper portion exhibiting nodular growth of sarcomatoid spindle cells. The tumor region lacked intradermal proliferation of atypical melanocytic cells, intracytoplasmic melanin, and expression of melanoma markers (except S-100 protein and Sox10). Although a malignant peripheral nerve sheath tumor derived from neurofibroma was possible, the slow growth with diffuse and strong immunoreactivity to the S-100 protein and Sox10 favored a diagnosis of desmoplastic melanoma. Pathologists should recognize that desmoplastic melanoma may not involve in situ lesions or the immunohistochemical expression of standard melanoma markers. Keywords: Desmoplastic melanoma, Malignant peripheral nerve sheath tumor, Neurofibroma, Neurotrophic melanoma

Sarcopenia is known to be associated with a worse prognosis following abdominal operations; however, the relationship between sarcopenia and the outcomes of pancreaticoduodenectomy remains unclear. We measured body composition parameters, including total abdominal muscle area, using preoperative staging computed tomography (CT), in patients undergoing pancreaticoduodenectomy for periampullary cancer. The incidence of sarcopenia among these patients was evaluated and multivariable analysis was performed to identify independent predictors of postoperative pancreatic fistula. We identified 335 consecutive patients who were eligible for the study. Patients with sarcopenia had significantly poorer 5-year survival rates than those without sarcopenia (32.4 vs. 51.6%, respectively, P = 0.009). Interestingly, the incidence of Grade B/C pancreatic fistula was significantly lower in the sarcopenia group than in the non-sarcopenia group. Multivariate analysis identified high body mass index and soft pancreatic texture as independent predictors of postoperative pancreatic fistula. Sarcopenia may have an independent prognostic effect on the survival of patients with periampullary cancer. Preoperative nutritional intervention and rehabilitation may improve the postoperative outcomes of pancreaticoduodenectomy for periampullary cancer.