シズイエン ノ ビョウタイ ケイセイ ニオケル Interferon-γ inducible protein 10(IP-10) ノ ヤクワリ

Dental pulp tissue surrounded by the hard tissue lacks epithelium lining and is in the special environment without the collateral circulatory system. For these specific anatomical characteristics, it is considered that the pulp tissue is easily led to irreversible pulpitis once this tissue is subjected to bacterial irritants. Therefore, to clarify the pathogenesis of pulpitis may lead to the development of new therapeutic approach to control this inflammation and improve the chance of spontaneous healing. The pulpitis is characterized as the immune response which is mainly triggered by invasion of the cariesrelated microorganisms into dental tubules and pulp. In this inflammation progresses, the significant inflammatory cells predominantly comprised of memory T cells and activated T cells infiltrates and recruitments into the lesion. However, these inflammatory infiltration mechanisms are far from being understood. Recently, it has been demonstrated that interferon-gamma-inducible protein-10 (IP-10), one of chemokines, have chemotactic activities against lymphocytes, binds to CXCR3 and then involves in the chemotaxis of CXCR3-positive activated T cells. It is conceivable that IP-10 may have an important regulatory role in activated T cell migration into inflamed tissue. Then, the purpose of this study is to elucidate the role of IP-10-CXCR3 system in the pathogenesis of pulpitis. First, in RT-PCR the expression levels of IP-10 mRNA in clinically inflamed pulp tissues were significantly increased than those in normal pulp tissue. Immunostaining results revealed that IP-10 was observed on fibroblasts, macrophages and endothelial cells in inflamed pulp tissue and CXCR3 was observed on lymphocytes migrated into pulp tissue. Second, the pulp fibroblast-like cells derived from normal dental pulp and PMA-differentiated human monocytic cell line (THP-1 cells) were stimulated with lived bacteria (Streptocossus mutans and Lactobacillus plantarum, which were reported to exist predominatly in dental caries lesions), lipoteichoic acids, peptideglycans, or various inflammatory cytokines in vitro. The result showed that IP-10 was secreted from cultured pulp fibroblasts and THP-1 cells, and that heat-killed S. mutans and L. plantarum did not induce IP-10 secretion. Taken together, this study suggests that the IP-10-CXCR3 system may play an important role in the immune response against the invasion of caries-related bacteria into dental pulp tissue beneath the carious lesion and may be involved in the progression of irreversible pulpitis

Technical Progress in Single-Incision Laparoscopic Cholecystectomy in Our Initial Experience

Single-incision laparoscopic cholecystectomy (SILC) has rapidly spread throughout the world because of its low invasiveness and because it is a scarless procedure. Various surgical methods of performing SILC are present in each institute; however, it is necessary to develop a standardized procedure that we can perform safely, such as the conventional 4-port laparoscopic cholecystectomy (LC). The SILC experiment in our institute was started by use of the commercial SILS Port and changed from a 3-port method via an umbilicus to a 2-port method to improve some problems. Although none of the conversions to conventional 4-port LC and also none of the complications such as bile duct injury occurred in each method, the 2-port method functioned best and was also economical. However, it is most important to adopt strict criteria and select the patients suitable for SILC to demonstrate SILC safety same as 4-port LC

Single-incision laparoscopic distal pancreatectomy.

Single-incision laparoscopic surgery (SILS) is a novel area of minimally invasive surgery, and rapidly evolving in the field of abdominal surgery. However, SILS is not a common procedure for pancreatic surgery. We describe our first experience with a SILS approach in a patient with a metastatic pancreatic tumor. We performed a SILS distal pancreatectomy (SILS-DP) using 3 trocars placed through a single port at an umbilical incision. In our case, the most important surgical technique was the stomach-hanging method to obtain a favorable laparoscopic view of the pancreas. Although SILS-DP is a safe and feasible procedure, further studies are required to determine the advantages of this procedure in comparison with the standard laparoscopic method

A Non-Randomized Comparative Study of Laparoscopy-Assisted Pancreaticoduodenectomy and Open Pancreaticoduodenectomy

Background/Aims: Laparoscopic surgery for periampullary disease is still a challenging operation. The aim of this study was to compare the perioperative outcomes of patients undergoing conventional pancreaticoduodenectomy (PD) with the outcomes of those undergoing laparoscopy-assisted PD. Methodology: A retrospective analysis was conducted on 51 consecutive patients who underwent laparoscopy-assisted or open PD for periampullary disease. Results: There were no significant differences in the preoperative demographic or clinical data of the two study groups. Although there were no significant differences in the operative time between the two study groups, blood loss in the laparoscopy-assisted PD group was significantly smaller than that in the open PD group. There were no significant differences in the occurrence of postoperative complications between the two groups. Conclusions: Laparoscopy-assisted PD is a feasible and safe surgical procedure that provides the advantages expected from a minimally invasive surgery including less blood loss

Laparoscopic Single-Branch Resection of the Pancreas for Intraductal Papillary Mucinous Neoplasm

Although laparoscopic pancreatic resections have become more common, laparoscopic minimally invasive and function-preserving pancreatic resections have not been widely accepted. Branch-type intraductal papillary mucinous neoplasm (IPMN) has a low-grade malignant potential and shows a favorable prognosis. In branch-type IPMN, minimal resection techniques with preservation of the pancreatic functional reserve have advantages over the more conventional pancreaticoduodenectomy. We describe herein laparoscopic single-branch resection of the pancreas for branch-type IPMN. This surgical procedure is a novel and an ideal minimally invasive method for the resection of branch-type IPMN. In addition, our endoscopic nasopancreatic drainage (ENPD) tube-guided technique is useful for precise resection of the tumor and for the prevention of pancreatic fistula

Combined pancreatic resection and pancreatic duct-navigation surgery for multiple lesions of the pancreas: intraductal papillary mucinous neoplasm of the pancreas concomitant with ductal carcinoma of the pancreas.

When a branch-type IPMN of the uncinate process is concomitant with ductal carcinoma of the body of the pancreas, total pancreatectomy may be recommended. However, a decrease in quality of life becomes a serious problem after total pancreatectomy because of the abolition of endocrine and exocrine pancreatic function. We proposed the combined resection, which consists of resection of the uncinate process of the pancreas with distal pancreatectomy. This surgical procedure of combined resection is most suitable for preservation of the pancreatic functions. In addition, we recommend the pancreatic duct-navigation surgery to enable us to prevent injury to the main pancreatic duct, and to dissect at the optimal cutting point of the pancreatic branch duct

Gastric wall-covering method prevents pancreatic fistula after distal pancreatectomy

Background/Aims: Pancreatic fistula is the most common complication after distal pancreatectomy. The aim of this study was to evaluate retrospectively the usefulness of a new surgical technique, the gastric wall-covering method, after distal pancreatectomy. Methodology: The study group consisted of 53 patients who underwent distal pancreatectomy. The management of the stump of the remnant pancreas was accomplished by the gastric wall-covering method (GWC group, n=20) or by conventional surgery (CS group, n=33). In the gastric wall-covering method, the cut surface of the pancreas is fixed to the posterior wall of the gastric body. Results: There were no significant differences in operating time, intraoperative blood loss, or texture of the remnant stump between the two groups. Postoperative pancreatic fistula was diagnosed in 1 patient (5.0%) in the GWC group and in 12 patients (36.4%) in the CS group (P=0.01). Conclusions: The gastric wall-covering method for the management of the pancreatic stump after distal pancreatectomy reduces the incidence of postoperative pancreatic fistula

Intraoperative pancreatography using an endoscopic naso-pancreatic drainage tube for the prevention of pancreatic fistula after local pancreatic resection

Background: Local pancreatic resections can avoid the unnecessary resection of the normal pancreatic parenchyma in comparison with standard pancreatic resection. However, the incidence of pancreatic fistula after local pancreatic resection is high, and still responsible for most morbidity and mortality. Methods: We reviewed 6 patients who underwent intraoperative pancreatography using an endoscopic naso-pancreatic drainage (ENPD) tube during local pancreatic resection for the prevention of postoperative pancreatic fistula. Results: One patient had injury to the main pancreatic duct during surgery, and transient pancreatic fistula of grade B occurred. In this patient, ENPD tube was left in place for the management the pancreatic fistula, resulted in a favorable outcome. Other 5 patients showed no postoperative complications including pancreatic fistula. Conclusions: Intraoperative pancreatography using ENPD tube is a simple technique and useful for the prevention of pancreatic fistula after local pancreatic resection

Quasi-logarithmic spacing law in dewetting patterns from the drying meniscus of a polymer solution

We report on a periodic precipitation pattern emerged from a drying meniscus via evaporation of a polystyrene solution in a Petri dish. It appeared a quasi-logarithmic spacing relation in the pattern as a result of stick-slip motion of the contact line towards the wall. A model based on the dynamics of the evaporating meniscus is proposed