Changes in Esophageal Blood Flow by Esophageal Transection with Devascularization

Changes in the blood flow in the wall of the esophagus were experimentally measured with the use of the hydrogen clearance method to evaluate the influence of operative procedure by transectional esophago-esophagostomy with paraesophageal and perigastric devascularization in the treatment of esophageal varices. As a result of this study, an approximately 30% reduction in blood flow of the adventitia was confirmed according to the procedure of paraesophageal devascularization. When performing a further procedure of esophageal transection, total blood flow was reduced to 50%. It is logical to conclude that the marked decrease in blood flow in the wall of the esophagus offers a great opportunity for the development of postoperative anastomosis insufficiency. It is of interest to note that the incidence of postoperative complications in the performance of this operation for esophageal varices has become significant on the basis of blood flow changes in the wall of the esophagus

Surgical Treatment for Carcinoma of the Esophagus Involving the Trachea, Bronchus and Lung in Terms of its Prognosis and Pathological Study

Key word: Carcinoma of the esophagus, A3 involving the trachea, bronchus, lung, pathology, prognosis. A total of 10 patients with carcinoma of the esophagus involving the trachea, bronchus and lung were operated upon. Their clinical features and histological patterns of cancer invasion were evaluated. In 5 patients involving the lung, the preoperative irradiation therapy was histologically effective in encircling the cancer lesions by induced scar formation. It was possible to render the resection to enhance its radicality. In 5 patients involving the trachea or the bronchus, it has become apparent that the membranous portion is more susceptible to cancer invasion and the structures of the cartilages on the tracheal and bronchial walls have a strong resistance to cancerous spread. The extent of cancer invasion on the trachea or bronchus was considerably limited. The sharp dissection at the site of occurrence of cancer invasion as an operative procedure of choice is sometimes beneficial in attempt to enhance the operative radicality when cancer invasion reaches to the adventitial layer. The prognosis, however, was not improved by an extended resection. It seems to be closely related to n-factor. None of them survived exceeding one year after surgery

Skip Metastases Extending to the Esophagus in Carcinoma of the Cardia

Eight cases with skip metastases to the esophagus in carcinoma of the cardia were pathologically analyzed in the genesis. These lesions were characterized by 1) deeply invaded carcinoma outside the gastric wall in carcinoma of the cardia 2) extended cancer spreading across the esophagocardiac junction 3) much more prominent histologic vascular invasion (ly) on the basis of histologic findings. We allege from this study that wide resection of the esophagus is necessary for the treatment of carcinoma of the cardia in which cancer in the cardia extends outside the gastric wall and spreads across the esophagocardiac junction

Peptide barcoding for one-pot evaluation of sequence–function relationships of nanobodies

遊離型抗体の構造活性相関解析を迅速に評価可能とする新手法を開発. 京都大学プレスリリース. 2021-11-08.Optimisation of protein binders relies on laborious screening processes. Investigation of sequence–function relationships of protein binders is particularly slow, since mutants are purified and evaluated individually. Here we developed peptide barcoding, a high-throughput approach for accurate investigation of sequence–function relationships of hundreds of protein binders at once. Our approach is based on combining the generation of a mutagenised nanobody library fused with unique peptide barcodes, the formation of nanobody–antigen complexes at different ratios, their fine fractionation by size-exclusion chromatography and quantification of peptide barcodes by targeted proteomics. Applying peptide barcoding to an anti-GFP nanobody as a model, we successfully identified residues important for the binding affinity of anti-GFP nanobody at once. Peptide barcoding discriminated subtle changes in KD at the order of nM to sub-nM. Therefore, peptide barcoding is a powerful tool for engineering protein binders, enabling reliable one-pot evaluation of sequence–function relationships

Development and External Validation of a Nomogram Predicting the Probability of Significant Gleason Sum Upgrading among Japanese Patients with Localized Prostate Cancer

Objective. The aim of this study is to develop a prognostic model capable of predicting the probability of significant upgrading among Japanese patients. Methods. The study cohort comprised 508 men treated with RP, with available prostate-specific antigen levels, biopsy, and RP Gleason sum values. Clinical and pathological data from 258 patients were obtained from another Japanese institution for validation. Results. Significant Gleason sum upgrading was recorded in 92 patients (18.1%) at RP. The accuracy of the nomogram predicting the probability of significant Gleason sum upgrading between biopsy and RP specimens was 88.9%. Overall AUC was 0.872 when applied to the validation data set. Nomogram predictions of significant upgrading were within 7.5% of an ideal nomogram. Conclusions. Nearly one-fifth of Japanese patients with prostate cancer will be significantly upgraded. Our nomogram seems to provide considerably accurate predictions regardless of minor variations in pathological assessment when applied to Japanese patient populations

Comparative Study between the jejunum and Colon as Substitute for the Esophagus in Terms of Blood Flow

The advantages over a substitute for attaining the continuity following resection of the esophagus were experimentally compared between the jejunum and the colon in terms of changes in blood flow in the vascular pedicles under the influence of mechanical tension, induced systemic hypoxia and hypotension. Blood flow of the pedicled jejunal and colonic grafts used were measured with the use of direct collection through catheter introduced to the pedicled vessel. 1) As for tension-load added to the pedicle, the colon was much more tolerable rather than the jejunum. When a 40g tension was added to the jejunum, blood flow was remarkably reduced whereas there was no significant change in the colon even when a 100g tension was added. 2) As for the influence of induced hypoxic load, blood flow to the pedicled grafts was reduced when the arterial Po2 fell to below 70mg and Pco2 over 50mg. 3) As for the influence of induced systemic hypotensive load, it was significantly reduced to below about 30% of the normal systemic blood pressure in the similar patterns between the jejunum and the colon

A Trial in Estimating Chemosensitivity from Biopsy Specimen by Flow Cytometry

To select the sensitive anticancer agents for the treatment of patients with carcinoma, chemosensitivity should be timely assessed from biopsy specimen for patients with gastric carcinoma. Histogram of DNA analysis from biopsy specimens revealed the disappearance of GZM accumulation in reflection of effects of anticancer drugs prior to the appearance of clinical signs. In conclusion, DNA analysis from biopsy specimens is of great value in assessing the efficacy of anticancer drugs in the course of drug treatment and also in knowing the drug sensitivity to the tumor timely

Regulatory T Cell as a Biomarker of Treatment-Free Remission in Patients with Chronic Myeloid Leukemia

Simple Summary Tyrosine kinase inhibitors (TKIs) have dramatically improved the treatment of chronic myeloid leukemia (CML). Recently, TKIs were discontinued in patients with CML with deep molecular remission, and some patients have been reported to be able to maintain long-term treatment-free remission (TFR). However, there is no certainty regarding which patients can maintain TFR. We focused on immunity in the TFR phase and investigated the immunological mechanism of continuous TFR or recurrence. Our results suggest that the group that maintains the TFR is immunologically activated. In addition, regulatory T cells can be used as a biomarker. These results may have important implications for future strategies for maintaining TFR in CML treatment. Treatment-free remission (TFR) has become a therapeutic goal in chronic myeloid leukemia (CML), and approximately half of the patients with chronic phase-CML (CML-CP) with deep molecular remission (DMR) by tyrosine-kinase inhibitors (TKIs) have achieved TFR. However, the mechanism of continuous TFR is still unclear, as there are fluctuate patients who have BCR-ABL-positive leukemia cells but do not observe obvious relapse. We focused on the immune response and conducted an immune analysis using clinical samples from the imatinib discontinuation study, JALSG-STIM213. The results showed that, in the group that maintained TFR for 3 years, changes in regulatory T (Treg) cells were observed early after stopping imatinib treatment. The effector Treg (eTreg) cells increased transiently at 1 month after stopping imatinib and then returned to baseline at 3 months after stopping imatinib treatment. There was no difference in the Treg phenotype, and CD8(+) T cells in the TFR group were relatively activated. High concentrations of imatinib before stopping were negatively correlated with eTreg cells after stopping imatinib. These data suggest immunological involvement in the maintenance of the TFR, and that Treg cells after stopping imatinib might be a biomarker for TFR. Furthermore, high imatinib exposure may have a negative immunological impact on the continuous TFR

Laparoscopic Partial Gastrectomy for Early Gastric Cancers using Plastic T-fasteners for Lifting Gastric Wall

Between September 1992 and July 1996, 2 patients with type I early gastric cancer, 3 with type IIa, and 14 with type IIc, totaling 19 patients underwent laparoscopic partial gastrectomy (gastric wedge resections in 17 and Billroth II distal gastric resection in 2). There were 12 men and 7 women. Mean age was 65.4 years ranging from 44 to 86. Gastric lesions were located on the anterior wall in 7, posterior wall in 8 and lesser curvature in 4. In 15 of 19 patients, we performed laparoscopic surgery by a lesion lifting method using plastic T-fasteners. Average operative time was 164.8±49.6 min (range 85-252) in all, 153.7±46.7 min for the lesion lifting method, and 227 ± 33 min for diatal gastrectomy. Average blood loss was 44.1 ± 57.3 ml, 30.9 ± 43.7 ml, and 97 ± 61 ml, respectively. Mean hospital stay after surgery was 13.6 ± 6.8 (6-30) days. There was no mortality and no postoperative complications. The average size of tumors in type I, IIa and lie was 30 mm, 17.3 mm and 20 mm, respectively. In histologic examination, 16 cases were differentiated carcinoma and the remaining 3 cases were signet cell carcinoma. One of 4 cases diagnosed as SM cancer preoperatively was m (mucosal) cancer, two were sm (submucosal), and one was mp (muscularis propria) cancer histologically, but no one was involved in regional lymph nodes. These results indicate that laparoscopic partial gastrectomy will play an increasing role in the treatment of early gastric cancer without lymph node involvement as well as benign gastric tumors