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Background Surgical resection of esophageal cancer is frequently performed to achieve a complete cure. However, the postoperative recurrence rate is 36.8–42.5%, leading to poor prognosis. Radiation therapy has been used to treat recurrences; solitary recurrence has been proposed as a prognostic factor for radiation therapy, though its significance is unclear. 18F-fluorodeoxyglucose positron emission tomography is a highly accurate diagnostic modality for esophageal cancer. This retrospective study aimed to analyze the outcomes of solitary postoperative recurrences of esophageal squamous cell carcinoma diagnosed with 18F-fluorodeoxyglucose positron emission tomography and treated with definitive radiation therapy. Methods We examined 27 patients who underwent definitive radiation therapy for single or multiple postoperative recurrences of esophageal squamous cell carcinoma between May 2015 and April 2021. 18F-fluorodeoxyglucose positron emission tomography/computed tomography was performed within 3 months before the commencement of radiation therapy. Kaplan–Meier, univariate, and multivariate analyses were performed to examine the overall survival and identify potential prognostic factors. Results The 1-, 2-, and 3-year overall survival rates were 85.2%, 62.6%, and 47.3%, respectively, and solitary recurrence was the only significant factor associated with overall survival (P = 0.003). The 1-, 2-, and 3-year overall survival rates in patients with solitary recurrence were 91.7%, 80.2%, and 80.2%, respectively, and in patients with multiple recurrences they were 80.0%, 50.3%, and 25.1%, respectively. Multivariate analysis also showed solitary recurrence as a significant factor for overall survival. Conclusions When diagnosed with 18F-fluorodeoxyglucose positron emission tomography/computed tomography, solitary recurrence appears to have a more favorable prognosis than multiple recurrences.

BACKGROUND: Handstand is the most important fundamental skill in gymnastics. A gradual and well-balanced increase in muscle loading in a manner is preferred for young beginners and/or recovering gymnasts to safely achieve the muscle strength required to perform a stable handstand. OBJECTIVE: To examine upper limb muscle activity during different levels of handstand training positions. METHODS: This study utilized four different positions for progressive handstand training; namely, the 90, 135, elbow stand, and handstand positions. The activities of eight upper limb muscles (upper, middle, and lower trapezius; serratus anterior; anterior and middle deltoid; infraspinatus; and latissimus dorsi were measured by surface electromyography (EMG) for each position. The percentages of EMG in each muscle compared to the values during maximum voluntary contraction were calculated and compared between the positions. RESULTS: Muscle activity around the shoulder increased gradually throughout the progression of the four handstand training positions. Furthermore, the muscles required for scapular stabilization, such as the upper and middle trapezius and serratus anterior muscles, were activated at levels similar to those for a handstand without performing this movement. CONCLUSIONS: A progressive handstand training program of four different positions resulted in gradual and well-balanced increases in muscle activity.

Background: Very few papers covering the anticancer activity of azulenes have been reported, as compared with those of antibacterial and anti-inflammatory activity. This led us to investigate the antitumor potential of fifteen 4,6,8-trimethyl azulene amide derivatives against oral malignant cells. Methods: 4,6,8-Trimethyl azulene amide derivatives were newly synthesized. Anticancer activity was evaluated by tumor-specificity against four human oral squamous cell carcinoma (OSCC) cell lines over three normal oral cells. Neurotoxicity was evaluated by cytotoxicity against three neuronal cell lines over normal oral cells. Apoptosis induction was evaluated by Western blot and cell cycle analyses. Results: Among fifteen derivatives, compounds 7, 9, and 15 showed the highest anticancer activity, and relatively lower neurotoxicity than doxorubicin, 5-fluorouracil (5-FU), and melphalan. They induced the accumulation of a comparable amount of a subG1 population, but slightly lower extent of caspase activation, as compared with actinomycin D, used as an apoptosis inducer. The quantitative structure–activity relationship analysis suggests the significant correlation of tumor-specificity with a 3D shape of molecules, and possible involvement of inflammation and hormone receptor response pathways. Conclusions: Compounds 7 and 15 can be potential candidates of a lead compound for developing novel anticancer drugs., Licensee MDPI, Basel, Switzerland.This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).

Pancreatic cancer has poor prognosis despite the various developed multimodal treatment strategies. Currently, neoadjuvant chemotherapy and immunotherapy have attracted substantial attention as effective treatment strategies. However, amplifying immune response with existing treatments is difficult. We developed telomerase-specific oncolytic adenoviruses (OAs), including OBP-301 that is currently tested in a clinical trial of combined anti-PD-1 antibody and p53-armed OBP- 301 variant(OBP-702). OAs have immune-modulation functions and induce CD8+ T cells into tumors by releasing immunogenic cell death markers, such as extracellular adenosine triphosphate. Here, we investigated the effectiveness of OBP- 702 in pancreatic cancer treatments, focusing on the influence on CD8+ memory T cells.

Cancer immune therapy is the most prominent topic in esophageal cancer. The attraction-3 trial showed that nivolumab was associated with a significant improvement in overall survival versus chemotherapy. This trial was well designed, including patients unresectable, after surgery, and after chemoradiotherapy. However, there are few reports limited to the recurrence after surgery. Here we report the outcome of Nivolumab for the recurrence after surgery with docetaxel, cisplatin, and 5-FU neoadjuvant chemotherapy (NAC-DCF). The subjects were esophageal cancer recurrent patients after NAC-DCF, except for the cases performed only best supportive care, in Okayama University Hospital between January 2014 and October 2021, excepted the cases performed only best supportive care. We assessed their background characteristics, treatment details, immune-related adverse events (irAE), and overall survival (OS). 17 patients received therapies, including Nivolumab (Nivo). 41 patients received other chemotherapies (Control). There was no significant difference in gender (Nivo: male 88%, Control male 80%), age (Nivo: 68.1±8.9, Control: 65.1±5.6), and the period from surgery to recurrence (Nivo: 5.7±3.8 months, Control: 6.1±3.7 months). The Median overall survivals were 27±7.0 months and 18±2.5 months (P=0.055, Log Rank test). The major irAEs were reported in 4 cases (ACTH deficiency: 1 event, enterocolitis: 1 event, liver dysfunction: 2 events). Nivolumab improved the outcomes of recurrent patients after NAC-DCF with a bit of tendency.

Advances in the optical instrument for endoscopic surgery have enabled the anatomical recognition of minute membranes and layers previously invisible in open surgery. Those have allowed surgeons to take the benefits of conversing with the tissue. Furthermore, the recent introduction of robot-assisted surgery has made it possible to dissect with fidelity and safety according to the layers envisaged by the surgeon. Furthermore, we are increasingly having conversations with the tissues during the surgery. Especially in the upper mediastinal lymph node dissection in esophageal cancer surgery, recognizing the delicate anatomy of the membranes and layers is an important technique. We have performed more than 600 thoracoscopic esophageal cancer surgeries in the prone position and more than 100 robot-assisted esophageal cancer surgeries. In our experience, we have tried to formulate the en bloc superior mediastinal lymph node dissection by applying the concept of microanatomy such as a visceral sheath, vascular sheath, and the meso-esophagus surrounded by a visceral sheath. We have established a technique to detach the visceral sheath from the surrounding organs, release the trachea to reveal the meso-esophagus, and dissect the lymphatic chain in en-bloc while rescuing only the recurrent nerve. The spread of the visceral sheath is not symmetrical. On the left side, it is recognized as a firm membrane up to the aortic arch, but on the right side, it seems to disappear at the cervicothoracic border. This left-right difference is understandable considering the difference in the development of the primitive aortic arch on each side during fetal heart development. In this study, we report on the technique and outcomes of upper mediastinal lymph node dissection based on the concept of the microanatomy of membranes and layers, which was developed through conversations with tissues in thoracoscopic esophageal cancer surgery, and its application to robot-assisted surgery.

In the treatment of advanced cervical esophageal cancer, the availability of laryngeal preservation has a great effect on quality of life. Factors affecting laryngeal preservation include tracheal invasion of the tumor, extension to the pharyngeal side, and duplication of head and neck cancer. In our institute, we provide multimodal treatment aiming at preserving the larynx as much as possible. We report on preoperative treatment and surgical outcome for patients with advanced cervical esophageal cancer. Of the 713 cases of esophageal cancer surgery from 2014 to March 2021, 29 cases of advanced cervical esophageal cancer were examined for preoperative treatment and surgical outcome. In our institution, non-T4 cases are first introduced with Docetaxel + Cisplatin +5-FU (DCF) chemotherapy. For cT4 cases and cases who DCF therapy did not respond, we added radiation therapy to DCF for local control. For resectable cases, we performed esophagectomy actively. The primary diagnosis was StageII:III:IV = 6:19:4 (UICC 8th). Preoperative treatment was performed in 28 cases, 26 cases with neoadjuvant chemotherapy (NAC), and 2 cases with chemoradiotherapy (CRT). NAC regimen was DCF in all cases. The therapeutic effect of NAC was evaluated PR in 15 of 26 cases and SD in 11. Laryngeal preservation was possible in 11 of 15 NAC-PR cases (73.3%) and 7 of 11 NAC-SD cases (63.6%), and the laryngeal preservation rate was higher in the NAC responder group. Recurrence was observed in 15 cases. 10 cases were in the laryngeal preservation group, but only 2 cases had local recurrence. This study suggests that the response of NAC may increase the laryngeal preservation rate. Laryngectomy does not necessarily contribute to the control of local recurrence. But patients with positive margins have a poor prognosis. And it is important to make an appropriate decision as to whether radiation therapy or surgery should be performed for patients who do not respond to chemotherapy.

We introduced robot-assisted thoracoscopic surgery for esophageal cancer surgery in 2018 and have performed 143 cases so far. Compared with thoracoscopic surgery, robot-assisted surgery is overwhelmingly more stable and precise, however there are concerns about the safety because there is no sensation from the forceps. Here, we will show a video of a standardized procedure utilizing the characteristics of da Vinci and its application to advanced cancer, and discuss the safe use of da Vinci. We compared the short-term outcomes of pretreatment cStage ≤ II (n=40) and cStage ≥ III (n=53) in a total of 93 single-operator cases out of 143 da Vinci esophageal operations performed at our department since 2018. For all patients, thoracoscopic time: mean 227 minutes, blood loss: 185 ml, recurrent nerve palsy: 15 patients (16.1%), postoperative hospital stay: 29.4 days, R0 surgery achievement rate: 96.8%. By stage (cStage ≤ II vs. ≥ III), thoracoscopic time: 211 vs. 240 minutes (p We focused on the effectiveness of robot-assisted thoracoscopic esophageal surgery for advanced cancer. Although robot-assisted surgery tends to take a relatively long time, we believe that it can be performed safely and effectively even for advanced cancer by careful surgical manipulation.

Stretching exercises conducted by oneself, herein referred to as self-stretching exercises, improve arterial stiffness in healthy people. Such exercises include voluntary contraction of peripheral muscles in addition to stretching of target muscles. However, the effects of static passive stretching without voluntary contraction of skeletal muscles on arterial stiffness remain unknown. In addition, it is important to verify the effects of stretching in the elderly lacking exercise habits with advanced arterial stiffness. Therefore, the purpose of the present study was to verify the acute effects of static passive stretching, without voluntary contraction of skeletal muscles, on the cardio-ankle vascular index (CAVI) in elderly individuals lacking exercise habits. The present study followed a pretest-posttest design without a control group. Twenty-nine elderly individuals (mean age, 77.8 ± 7.0 years; 24 female) recruited at an orthopedic clinic participated in the present study. The participants were subjected to static passive stretching of the neck, trunk, and extremities for 40 min by the same physical therapist. Stretching involved the shoulder flexors/extensors, elbow flexors/extensors, wrist palmar flexors/dorsal flexors, hip flexors/extensors/adductors, knee flexors/extensors, ankle plantar flexors/dorsal flexors, neck muscles, and trunk muscles. The CAVI (Rt, Lt, Ave), ankle-brachial index (ABI), blood pressure, and pulse rate were assessed before and after stretching. After stretching, both CAVI (Lt, Ave) and pulse rate were significantly decreased. In contrast, no significant changes in CAVI (Rt), ABI, or blood pressure were observed. The key new finding of the present study was that static passive stretching without voluntary contraction of skeletal muscles acutely improved the CAVI in elderly individuals lacking exercise habits.

An aberrant right subclavian artery (ARSA) is one of the famous anatomical abnormalities with a prevalence of 0.16-4.4%. In esophagectomy, anatomical abnormalities of the ARSA could cause complications with some surgical procedures. An 85-year old man was referred to our department for esophageal adenocarcinoma that was at a slightly high position for esophagectomy with the abdominal approach. However, he had a significant past medical history. This risk factor made it difficult to perform thoracoscopic esophagectomy. He underwent mediastinoscopic esophagectomy (ME) with the left cervical and laparoscopic approach. The ARSA presented no difficulties with the ME surgical technique including the dissection of the left recurrent laryngeal nerve lymph node. Although this patient had a respiratory dysfunction and some difficulties in a prone position, ME enabled a safe esophagectomy with lymph node dissection.

Locally advanced esophageal cancer (EC) invading surrounding organs (T4b) is difficult to treat. In general, definitive chemoradiotherapy (d-CRT) has been chosen as treatment for such cases. However, the outcome has not been good. Recently, the effectiveness of d-CRT with docetaxel, cisplatin, and 5-fluorouracil (DCF-RT) has been reported. Furthermore, surgery after d-CRT has a better prognosis than d-CRT alone in some reports, although it has a high risk of surgical complications. This study investigated the effectiveness and safety of induction DCF-RT. The subjects were EC patients who underwent induction DCF-RT in Okayama University Hospital between January 2011 and December 2017. Their background characteristics, treatment details, histopathological factors, adverse events during CRT, postoperative complications, and overall survival (OS) were assessed. A total of 16 cases were performed induction DCF-RT. In 10 cases, death occurred, with 9 cancer-related deaths, and 1 death due to other disease. For all cases, OS was 37.5% at 3 years. 12 cases underwent esophagectomy after DCF-RT. Their OS was 50% at 3 years. 13 patients (81.3%) had Grade 3 febrile neutropenia. In 7 cases (62.5%), fasting for the treatment of diarrhea was needed. Three patients (25%) developed anastomotic leakage. Some recurrent laryngeal nerve paralysis was observed in 6 cases (50%). Although the rates of adverse events and surgical complications were slightly higher than in past reports, they were acceptable. It is useful to perform induction DCF-RT for T4b EC.

An 84-year-old man underwent laparoscopic descending colon resection for colon cancer with stage Ⅰ. Follow-up computed tomography(CT), 18 months after surgery showed a soft tissue density nodular mass, 30 mm in size, in the small intestinal mesentery. The surgical resection of the tumor was performed after a thorough examination. Histopathological examination showed spindle-shaped fibroblasts and abundant collagen fibers. Immunohistochemical staining was negative for c-kit and CD34 and positive for α-SMA and β-catenin. From the above, this tumor was diagnosed as intra-abdominal desmoid tumor.

The standard treatment for locally advanced esophageal cancer is preoperative chemotherapy with cisplatin and 5-fluorouracil (CF), followed by surgery. Although docetaxel plus cisplatin and 5-fluorouracil (DCF) has been reported to have favorable outcomes, no study has compared its therapeutic efficacy to that of standard treatment. This study aimed to compare the therapeutic effects of CF and DCF in the real world by matching patient background factors using propensity scores.We retrospectively reviewed the data of 237 patients with esophageal squamous cell carcinoma who underwent esophagectomy between January 2008 and December 2018. Patients were divided into two groups based on the preoperative chemotherapy regimens of CF (79 patients) or DCF (158 patients), and 49 matched pairs were finally analyzed using propensity score matching. Short- and long-term outcomes were compared between groups.After matching, although no significant differences in survival were observed among the groups, patients receiving DCF showed a significantly high histological response (P 0.001). Subgroup analyses demonstrated that DCF therapy had better overall survival (P = 0.046) and relapse-free survival (P = 0.010) among pathological T3 and T4 cases. Whereas, adverse effects of chemotherapy were more frequent in the DCF group.Patients receiving DCF had higher pathological response and better survival than those receiving CF, especially in pathological T3 and T4 cases matched using propensity scores. Thus, the DCF regimen might be an effective treatment for locally advanced esophageal cancer. However, the adverse side effects of chemotherapy remain high and should be handled appropriately.

The case was a 67-year-old male, who underwent right hemicolectomy+D3 LN resection for ascending colon cancer at the age of 47, and pathological diagnosis was tub1tub2, T3, N0, M0, ly1, v1, Stage Ⅱa. 20 years after the first surgery, he visited our hospital for intermittent abdominal pain and abdominal fullness. CT scan showed stenosis and wall thickening at the anastomosis of the ileum and colon. When combining the detail examination by upper and lower gastrointestinal endoscopy and PET-CT scan, the tumor was clinically diagnosed asynchronous colon cancer, duodenal invasion. Partial resection of transverse colon and duodenal combined resection was performed. The pathological diagnosis was local recurrence of previous ascending colon cancer. Postoperative adjuvant chemotherapy was performed, but it was discontinued due to poor appetite. Currently, it has not recurred 7 months after the surgery. Recurrences more than 5 years after resection of colorectal cancer are rare, and reports of local recurrence are even rare. A long-term prognosis may be expected for early detection and treatment. Even if more than 5 years passed since the surgery, examination and treatment should be performed with recurrence in mind.

Context Tramadol is conditionally recommended for cancer pain and is a less expensive drug compared to strong opioids. Thus, tramadol may help reduce health care costs. Objectives To investigate factors that predict the clinical efficacy of tramadol for cancer pain. Methods A retrospective study using electronic medical records was conducted on patients who received tramadol for cancer pain from January 2016 to December 2020. Patients who continued tramadol for >28 days or discontinued tramadol before 28 days owing to pain improvement were considered as clinical efficacy cases. Results We identified 183 eligible patients; 104 cases had clinical efficacy. The median starting tramadol daily dose was 100 mg, and the median administration duration was 22 days. Overall, 169 patients (92.3%) discontinued tramadol; pain improvement was the most common reason (34.9%). Age (>70 years), a performance status of 0-1, and an albumin-bilirubin grade of 1 were independent predictors for the clinical efficacy of tramadol. Patients with multiple predictors had significantly higher achievement rates than those without. Conclusion Tramadol could have greater clinical efficacy for cancer pain in patients who are elderly, have good performance status, and have good liver function.

Immune checkpoint inhibitors, including anti-programmed cell death 1 (PD-1) antibody, provide improved clinical outcome in certain cancers. However, pancreatic ductal adeno-carcinoma (PDAC) is refractory to PD-1 blockade therapy due to poor immune response. Oncolytic virotherapy is a novel approach for inducing immunogenic cell death (ICD). We demonstrated the therapeutic potential of p53-expressing telo-merase-specific oncolytic adenovirus OBP-702 to induce ICD and anti-tumor immune responses in human PDAC cells with different p53 status (Capan-2, PK-59, PK-45H, Capan-1, MIA PaCa-2, BxPC-3) and murine PDAC cells (PAN02). OBP-702 significantly enhanced ICD with secretion of extracel-lular adenosine triphosphate and high-mobility group box pro-tein B1 by inducing p53-mediated apoptosis and autophagy. OBP-702 significantly promoted the tumor infiltration of CD8+ T cells and the anti-tumor efficacy of PD-1 blockade in a subcutaneous PAN02 syngeneic tumor model. Our results suggest that oncolytic adenovirus-mediated p53 overexpres-sion augments ICD and the efficacy of PD-1 blockade therapy against cold PDAC tumors. Further in vivo experiments would be warranted to evaluate the survival benefit of tumor-bearing mice in combination therapy with OBP-702 and PD-1 blockade.

The rate of aging in Japan has currently exceeded 28.1%. Moreover, it is expected that the rate of aging will continue to increase in the future. Under these circumstances, the opportunities to treat breast cancer in the super-elderly individuals are elevating. Here, we summarized and examined the cases who were 85 years or above in age and diagnosed with breast cancer at our hospital during the last 10 years. There were 29 cases(30 breasts), who were all female, with an average age of 89.6 years. Dementia coexisted in 17 cases, and an enlarged mass was the trigger for the discovery in most cases. For breast cancer in super-elderly females, it is necessary to treat it in the right proportion. Moreover, it is considered that the treatment policy should be decided considering the presence or absence of dementia and comorbidities. Also, the treatment regime should be decided upon full consultation with the surroundings, such as family members and long-term care facilities.

The case involved a 51-year-old woman who was diagnosed with Stage Ⅰ right breast cancer(cT1, N0, M0). Partial resection of the right breast and sentinel lymph node biopsy were performed. The histological type was found to be Stage Ⅰ triple-negative medullary carcinoma with pT1c, pN0(sn), and M0. A pituitary tumor was diagnosed after discharge. After removal of the pituitary tumor, whole-breast irradiation was performed. Subsequently, chemotherapy was started. Approximately 5 months after surgery, redness and swelling of the right breast were observed. Inflammatory breast cancer recurrence could not be ruled out by imaging, and skin biopsy was performed. No malignant findings were observed, and the symptoms were considered to indicate radiation recall dermatitis caused by chemotherapy. When chemotherapy was discontinued, the redness of the right breast improved.