Morphological and Molecular Changes of the Myocardium After Left Ventricular Mechanical Support

Left ventricular assist devices (LVAD) are currently used to either “bridge” patients with terminal congestive heart failure (CHF) until cardiac transplantation is possible or optionally for patients with contraindications for transplantation (“destination therapy”). Mechanical support is associated with a marked decrease of cardiac dilation and hypertrophy as well as numerous cellular and molecular changes (“reverse cardiac remodeling”), which can be accompanied by improved cardiac function (“bridge to recovery”) in a relatively small subset of patients with heart transplantation no longer necessary even after removal of the device (“weaning”). In the recent past, novel pharmacological strategies have been developed and are combined with mechanical support, which has increased the percentage of patients with improved clinical status and cardiac performance. Gene expression profiles have demonstrated that individuals who recover after LVAD show different gene expression compared to individuals who do not respond to unloading. This methodology holds promise for the future to develop read out frames to identify individuals who can recover after support. Aside from describing the morphological changes associated with “reverse cardiac remodeling”, this review will focus on signal transduction, transcriptional regulation, apoptosis, cell stress proteins, matrix remodeling, inflammatory mediators and aspects of neurohormonal activation in the failing human heart before and after ventricular unloading

An Evaluation of the Effect of the Improvised Experiments on Student-teachers’ Conception of Static Electricity

This study is investigating the student-teachers’ conception of static  electricity in Rwandan teacher training colleges. The study used a preand post-intervention design, where two groups of students were randomly  assigned in two groups. Along a period of four weeks, one group was taught using the traditional method (TRAD) while another using improvised  experiment (IME) method. The student-teachers were given a test before teaching while after teaching the same test was administered to both groups. The study was not interested in testing student-teachers’  achievement rather the conception of static electricity. The test was composed of six item questions and their answers were coded as “out of the topic, unrelated information and opposite answers”. After performing pre-test, student-teachers showed confusions related to non-mastery of content and alternative conceptions related to static electricity and  magnetism. Though about 27 per cent and 17 per cent of student-teachers in TRAD and IME respectively, reduced the gaps in their confusion after getting teaching intervention, however, there was found to be no statistically significant difference (p>.05 at df=10) in all of the item questions between these teaching methods in favour of IME. Four item questions showed an improvement while student-teachers developed more conceptual confusions in other two item questions. Not only examining student-teachers’ conception in static electricity but also teachers were recommended to be aware of students’ ideas, opinions and confusions prior to their lesson planning, teaching materials preparation, as well as teaching implementation. Keywords: Conceptions, Static electricity, Improvised experiments, Student-teacher

カガク ホウシャセン リョウホウ カンジュセイ ニヨル ショクドウガン チリョウ ノ コベツカ ニ カンスル ケンキュウ

食道癌に対しては従来より手術治療法が標準治療とされてきたが、治療法の多様化と進歩に伴い、個々の症例に応じた治療法が選択されるようになってきた。特に化学放射線療法は外科治療に匹敵する程の治療成績が報告されるようになった。一方で効果 が不十分であったり、癌が再燃した場合にはsalvage手術の適応となるが、術死が12-15％と大変riskが高いため、治療効果をあらかじめ予測し、個別化治療を確立することが急務である。 　本研究では、術前治療としての放射線照射と5FU+CDDPによる化学療法の効果を癌関連遺伝子変異、3DCT、PETにて評価し、治療効果予測を検討した。 　これまでの検討で、以下の点が明らかとなった。 １）p21(-), (+)のCRT後組織学的Grade3は13.5% vs 44%とp21(+)で有意に治療効果が高かった。 ２）治療前後のPETでの効果予測と組織学的評価の対比では特にPETではリンパ節の効果予測が正確にはできなかった。 ３）照射野内外でのリンパ節への治療効果の検討で照射野外では効果が低かった。 ４）PETのSV値の変化でCRTの組織学的効果を予測するのは必ずしも十分ではなかった。 ５）CRT＜40GyまでのA群、50Gy＜のB群ではTunnel index 8.8% vs 11.6%,MIB-1 index 40.2% vs 12.3%、照射野内リンパ節の組織学的効果12％ vs 20%であった。 ６）3DCTによるvolumetryでの評価は臨床的治療効果を判定する上で有用であり、また組織学的効果判定との相関も認められた。 現時点では種々のBiomarkerや画像診断による食道癌に対するCRTの組織学的効果予測は必ずしも十分ではなく、今後更なる精度の高い効果予測法の確立が重要である

LINE-1 hypomethylation in gastric cancer, detected by bisulfite pyrosequencing, is associated with poor prognosis

BACKGROUND: Genome-wide DNA hypomethylation plays an important role in genomic instability and carcinogenesis. DNA methylation in the long interspersed nucleotide element-1, L1 (LINE-1) repetitive element is a good indicator of the global DNA methylation level. In some types of human neoplasms, LINE-1 methylation level is attracting interest as a predictive marker for patient prognosis. However, the prognostic significance of LINE-1 hypomethylation in gastric cancer remains unclear. METHODS: Using 203 resected gastric cancer specimens, we quantified LINE-1 methylation using bisulfite-pyrosequencing technology. A Cox proportional hazards model was used to calculate the hazard ratio (HR), adjusted for the clinical and pathological variables. RESULTS: Gastric cancers showed significantly lower LINE-1 methylation levels compared to matched normal gastric mucosa (p < 0.0001; n = 74). Tumoral LINE-1 methylation range was 11.6–97.5 on a 0–100 scale (n = 203; mean 71.4, median 74.4, standard deviation 12.9). LINE-1 hypomethylation was significantly associated with shorter overall survival [log-rank p = 0.029; univariate HR 2.01, 95 % confidence interval (CI) 1.09–3.99, p = 0.023; stage-matched HR 1.88, 95 % CI 1.02–3.74, p = 0.041; multivariate HR 1.98, 95 % CI 1.04–4.04, p = 0.036]. No significant effect modification was observed by any of the covariates in survival analysis (all p interaction >0.25). CONCLUSIONS: LINE-1 hypomethylation in gastric cancer is associated with shorter survival, suggesting that it has potential for use as a prognostic biomarker

Prognostic relevance of autophagy-related markers LC3, p62/sequestosome 1, Beclin-1 and ULK1 in colorectal cancer patients with respect to KRAS mutational status

Raw data converted from SPSS to Excel. (XLSX 18 kb

Successful esophageal bypass surgery in a patient with a large tracheoesophageal fistula following endotracheal stenting and chemoradiotherapy for advanced esophageal cancer: case report

A 63-year-old man with esophageal achalasia for more than 20 years complained of respiratory distress. He was admitted as an emergency to the referral hospital three months previously. Computed tomography revealed tracheobronchial stenosis due to advanced esophageal cancer with tracheal invasion. He underwent tracheobronchial stenting and chemoradiotherapy. A large tracheoesophageal fistula (TEF) developed after irradiation (18 Gy) and chemotherapy, and he was unable to eat. Thereafter, he was referred to our hospital, where we performed esophageal bypass surgery using a gastric conduit. A percutaneous cardiopulmonary support system was prepared due to the risk of airway obstruction during anesthesia. A small-diameter tracheal tube inserted into the stent achieved ordinary respiratory management. No anesthesia-related problems were encountered. Oral intake commenced on postoperative day 9. He was discharged on postoperative day 23 and was able to take in sustenance orally right up to the last moment of his life. Esophageal bypass under general anesthesia can be performed in patients with large TEF with sufficient preparation for anesthetic management

Successful Treatment of Cisplatin Overdose with Plasma Exchange

Accidental cisplatin overdose has been occurring with an increasing frequency due to expanding usage of the agent. However, the optimal strategy to treat such patients remains to be established. Here, we report a case of large cisplatin overdose, successfully managed by plasma exchange, intravenous hydration, granulocyte colony-stimulating factor (G-CSF) administration, and other supportive care. A 67-year-old man with esophageal carcinoma received a large cisplatin overdose of 240 mg/m2, when he received adjuvant therapy following subtotal esophagectomy. On day 4, he experienced frank cisplatin toxicities and emergency plasma exchange was initiated. With 7 cycles of plasma exchange, the cisplatin concentration decreased from 2,350 to 110 ng/mL. Severe bone marrow suppression with high fever ensued on day 10, which was successfully treated with G-CSF and antibiotics. Despite moderate hearing sense reduction, he recovered without significant complications. Immediate plasma exchange with hydration and other care was efficacious in quickly lowering cisplatin concentrations