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The aim of this study is to explore pivotal preoperative findings of small bowel ischemia in patients with small bowel obstruction. We enrolled 285 consecutive patients with small bowel obstruction requiring in-hospital treatment. The clinical parameters involved in small bowel ischemia were retrospectively explored. Non-enhanced computed tomography (CT) findings were analyzed. The definition of bowel ischemia was pathologically determined. The median age of the patients was 74. A total of 127 patients underwent surgery, and small bowel ischemia was observed in 26 patients. Univariate analysis revealed that ascites on CT (p = 0.0005), mesenteric haziness on CT (p < 0.0001), closed loop sign on CT (p < 0.0001), wall thickness ≥ 4 mm on CT (p = 0.0003), ascites CT level ≥ 15 Hounsfield units (HU) on CT (p = 0.0176), intestinal fluid CT level ≥ 12 HU on CT (p = 0.0052), and white blood cell > 15,000 /μL (p = 0.0223) were correlated with small bowel ischemia. Multivariate logistic regression analysis revealed that mesenteric haziness on CT (p = 0.0131), closed loop sign on CT (p = 0.0002), and intestinal fluid CT level ≥ 12 HU on CT (p = 0.0056) were independently correlated with small bowel ischemia. An intestinal fluid CT level ≥ 12 HU could be a new clinical predictor of bowel ischemia in addition to the well-known predictors of mesenteric haziness and closed loop sign on CT in patients with small bowel obstruction. [ABSTRACT FROM AUTHOR]

Statins are cholesterol-lowering agents that act as inhibitors of 3-hydroxy-3-methyl-glutaryl-coenzymeA (HMG CoA) reductase. Recently, statins have received a lot of attention, especially regarding how statins act on the immune system. Here, the clinical impact of statin intake was examined in patients with resected pancreatic cancer, and the underlying mechanisms were investigated in vitro and in vivo . We found that statin intake was associated with favorable prognostic outcomes in patients with resectable pancreatic cancer. Statins, especially lipophilic statins, exert anti-proliferative effects on pancreatic cancer cells in vitro (simvastatin > fluvastatin > atorvastatin > rosuvastatin > pravastatin). Simvastatin had an anti-proliferative effect on pancreatic cancer cells with decreased the yes-associated protein (YAP)/PDZ-binding motif (TAZ) expression by activating the JNK pathway, and simvastatin treatment with oxaliplatin revealed additive anti-growth effects. Furthermore, lipophilic and hydrophilic statins suppressed programmed cell death ligand 1 (PD-L1) expression by downregulating TAZ. Simvastatin treatment with an anti-PD-1 drug (BP0273) provided immediate anti-growth effects compared to controls, such as anti-PD-1 only and simvastatin only, and suppressed progressive disease during the early period of anti-PD-1 treatment in vivo . In conclusion, Statins display two distinct anti-cancer effects (direct anti-growth effect and elimination of immune suppression by downregulating PD-L1 expression) by targeting YAP/TAZ expression., Competing Interests: None., (AJCR Copyright © 2023.)

Aim: The objective of this study was to examine the clinical and biological significance of CD44 expression in conversion hepatectomy for initially unresectable colorectal liver metastases., Methods: Fifty-four patients who received chemotherapy followed by hepatectomy (conversion hepatectomy) for initially unresectable liver metastases were enrolled. CD44 expression and its clinical significance were examined in 52 resected specimens; two specimens revealed no residual cancer cells. The biological significance of CD44 expression in the chemoresistance response to fluorouracil, oxaliplatin or irinotecan, three major anti-cancer agents for colon cancer in the clinical setting, was examined using colon cancer cell lines., Results: Membrane CD44 expression in the residual cancer cells after chemotherapy for colorectal liver metastases was detectable in 19 patients (37%), and was significantly associated with high proliferative activity represented by Ki-67 expression ( P = 0.003). CD44 expression was also significantly associated with shorter disease-free survival and worse overall survival after hepatectomy (hazard ratio and P -values were 2.570, 0.007 and 3.457, 0.026, respectively). In SW480 and HT29 colon cancer cells, siRNA-mediated CD44 knockdown attenuated cell growth. Additionally, CD44 knockdown overcame chemoresistance in response to fluorouracil and oxaliplatin with enhanced apoptosis and p27 upregulation, respectively. For irinotecan, CD44 knockdown showed no additional effect in chemoresistance., Conclusions: CD44 enhances chemoresistance in response to anti-cancer drugs (fluorouracil and oxaliplatin) in colon cancer cells. CD44 expression in liver metastases after chemotherapy implies the presence of occult micrometastases and is a worse prognostic factor in patients with conversion hepatectomy for initially unresectable colorectal liver metastases., Competing Interests: None., (AJTR Copyright © 2020.)

A 62-year-old man was underwent sigmoidectomy for sigmoid colon cancer(T3N1H0P0, Stage III a). He received a postoperative systemic chemotherapy with SOX. Five months after the operation, multiple liver metastases were detected by CT scan. Systemic chemotherapy(bevacizumab and SOX, bevacizumab and FOLFIRI)did not reduce the liver metastases. So 4 courses of hepatic arterial infusion(HAI)chemotherapy with CDDP 10mg/day and 5-FU 500mg/day for 2weeks were performed without severe adverse events. All the liver metastases decreased in size remarkably, and the hepatic resection was able to be performed. We think HAI chemotherapy is one of the useful options for resistance to systemic chemotherapy for liver metastases from colorectal cancer.