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Background and Aim: High mobility group box chromosomal protein‐1 (HMGB‐1) is a potential late mediator of sepsis and a possible risk factor for postoperative pulmonary complications after esophagectomy. This study aimed to determine the relationship between HMGB‐1 and clinicopathological factors and long‐term prognosis after esophagectomy for esophageal cancer. Methods: We measured perioperative serum HMGB‐1 levels using ELISA and HMGB‐1 protein by immunohistochemistry expression in resected specimens. Results: Postoperative serum HMGB‐1 levels were significantly higher than preoperative levels. Preoperative serum HMGB‐1 levels were significantly higher in patients with more intraoperative bleeding, longer intensive care unit stays, and postoperative pneumonia. Postoperative serum HMGB‐1 levels were significantly higher in older patients and those with longer operation time and more intraoperative bleeding. There were significant differences in long‐term outcomes according to postoperative but not preoperative serum HMGB‐1 levels. Multivariate analysis demonstrated that advanced pathological stage, postoperative pulmonary complications, and higher postoperative serum HMGB‐1 levels were independently associated with relapse‐free survival and overall survival. Preoperative serum HMGB‐1 levels were significantly higher in patients with high HMGB‐1 expression than those with low HMGB‐1 expression by immunohistochemistry, whereas such statistical differences were not observed in postoperative serum HMGB‐1. There were no differences in relapse‐free survival and overall survival according to HMGB‐1 expression by immunohistochemistry. Serum HMGB‐1 levels were significantly increased after esophagectomy for esophageal cancer. Conclusion: Elevated postoperative serum HMGB‐1, which was associated not only with poor long‐term but also short‐term outcomes such as postoperative complications, might serve as a potential marker for prognosis in esophageal cancer. [ABSTRACT FROM AUTHOR]

Background: Although sepsis-induced immunosuppression has long been considered to be a factor in the late mortality of patients with sepsis, little is known about regulatory T cell (Treg)–mediated immunosuppression and the effect of polymyxin B-immobilized fiber (PMX-F) on sepsis-induced immunosuppression. We sought to investigate the role of CD4+CD25+Foxp3+ Tregs in septic patients, and to evaluate the effect of hemoperfusion with PMX-F on the recovery from immunosuppression owing to septic shock. Methods: Thirty-two septic patients who had an identified focus of infection in the abdominal cavity were enrolled in this study. Peripheral blood mononuclear cells in the septic patients were examined to evaluate the roles of Tregs and the serum cytokine levels. We also examined the effects of PMX-F therapy on CD4+ T cells, especially Tregs and serum cytokine levels in patients with septic shock. Results: The percentage of Tregs in the CD4+ T-cell population, and the serum IL-6 and IL-10 levels, were significantly higher among patients with septic shock compared with those without septic shock, and PMX-F therapy significantly decreased the number of Tregs, as well as the serum IL-6 and IL-10 levels. Furthermore, a significant increase in the number of CD4+ T cells, a significant decrease in the percentage of Tregs in the CD4+ T-cell population, and a significant decrease in the serum IL-6 and IL-10 levels 24 hours after PMX-F therapy were observed in septic shock survivors compared with nonsurvivors. Conclusion: We found a major increase in the percentage of Tregs in peripheral blood circulating CD4+ T cells from patients with septic shock, and observed that the removal of Tregs by hemoperfusion with PMX-F might represent a novel strategy for inducing recovery from the immunosuppression associated with sepsis. [ABSTRACT FROM AUTHOR]

Objectives: To investigate the role of CD4+CD25+Foxp3+ regulatory T cells (Tregs) in septic conditions, and to examine the potential of targeting them for the treatment of sepsis. Background: Sepsis-induced immunosuppression has long been considered a factor in late mortality of patients with sepsis. Although Tregs are central to the maintenance of immunologic homeostasis and tolerance, little is known about Treg-mediated immunosuppression in the late stages of sepsis. Methods: Peripheral blood mononuclear cells (MNCs) in septic patients and liver or spleen MNCs collected after a cecal ligation and puncture (CLP) model in C57BL/6 mice were examined to evaluate the roles of Tregs and the correlation of transforming growth factor (TGF)-β or interleukin (IL)-10 with their activity. We next examined the effects of neutralization of TGF-β or IL-10 on the percentages of Tregs in CD4+ T cells and the survival rates of septic mice. Results: The percentages of Tregs in peripheral blood lymphocytes were significantly increased in patients with sepsis, and there was a significantly positive correlation between serum IL-10 levels and the percentage of Tregs. CLP injury increases the percentages of Tregs in the CD4+ T cells in the spleen, and there was a significantly positive correlation between the percentages of Tregs and the serum IL-10 or TGF-β levels. The neutralization of TGF-β or IL-10 decreased the percentages of Tregs in CD4+ T cells, restored the percentages of CD4+ T cells in spleen MNCs, and improved survival rates in septic mice. Conclusion: We found an increase in the percentages of Tregs in peripheral blood circulating CD4+ T cells from patients with sepsis, and in splenic MNCs from septic mice, and observed that regulation of Tregs by neutralizing IL-10 or TGF-β might represent a novel strategy for treating the immunosuppressive conditions in sepsis. [ABSTRACT FROM AUTHOR]

The purpose of this study was to evaluate the merits of the sentinel node (SN)-navigated reduced gastrectomy (SNRG) procedure. The subjects (sT1N0) were divided into the SNRG group (n=34) and the GL group, that consisted of patients which underwent gastrectomy according to the Japanese Gastric Cancer Association guidelines (n=33). We compared the area of the resected stomach and evaluated their body weight changes, and the results of a questionnaire survey about postoperative symptoms, and nutritional effects by blood tests administered at postoperative months (POM) 3, 6 and 12. The median area of the resected stomach was 104 cm2 in the SNRG group vs. 192 cm2 in the GL group. The body weight loss ratio was -5.9±5.8 vs. -9.3±4.1% at POM 3, and the henoglobin (g/dl) change rate was -1.1±7.9 vs. -6.4±6.5% at POM 12 in the SNRG and GL groups, respectively. There were no significant differences regarding the passage of food, reflux, the incidence of dumping syndrome, digestive and excretory function, or general condition and the satisfaction levels of the patients. In conclusion, SNRG has some advantages over GL in terms of postoperative disorders for at least one year after surgery, and is the recommended choice of a surgical procedure for early gastric cancer.

The objective of this study was to evaluate the multidetector computed tomography (MDCT) attenuation value between the tumor and aorta in response to the induction therapy for esophageal cancer. In advanced esophageal cancer, the main reason for unresectability is the local invasion of the tumor into the aorta or trachea. Despite remarkable advances in diagnostic modalities, pre-operative assessment of pathological response and local tumor extent in esophageal cancer remains difficult. MDCT attenuation values between the tumor and aorta, and the contact angle of the tumor to the aorta (Picus' angle) were retrospectively evaluated in patients with esophageal cancer who underwent induction therapy in terms of predicting the pathological response, aortic invasion and prognosis of esophageal cancer. The induction therapy may increase the tumor-to-aorta distance and decrease the maximum tumor size and Picus' angle. When the tumor-to-aorta cut-off value was set at <1.3 mm, the accuracy of this distance for aortic invasion was 94.6%. In terms of this distance, 14 out of 19 patients with a tumor-to-aorta distance of <1.3 mm prior to the induction therapy had a distance of >1.3 mm following therapy and underwent curative resection. The assessment of the MDCT attenuation value between the esophageal tumor and the aorta is simple and objectively assesses the response to the induction therapy and aortic invasion in esophageal cancer. This method should be applied to predict the response to the induction therapy and to prevent unnecessary surgery in patients with tumors involving the aorta.