Role of the expression of collagen prolyl-4-hydroxylase α subunits 1 and 2 in the development and prognosis of breast cancer

　Background: The expression of prolyl-4-hydroxylase (P4H), an enzyme involved in collagen biosynthesis, is significantly upregulated during breast cancer development and progression. However, the molecular mechanisms by which P4H expression in cancer cells induces progression have not been elucidated. Thus, we aimed to determine the significance of the expression of isoforms 1 and 2 of P4H in breast cancer.　Methods: We performed immunohistochemical analysis for P4HA1 and P4HA2 on the tumor samples obtained from 182 patients with breast cancer and examined the correlation between clinicopathological factors and markers related to epithelial-mesenchymal transition and ischemia. Protein expression levels were investigated using western blotting. In addition, breast cancer cell cultures were used to characterize the expression.　Results: Expression of both P4HA1 and P4HA2 was upregulated in cancer cells compared with that in normal mammary glands; the high-P4H expression group tended to have a poorer prognosis than the low-P4H expression group. In particular, P4HA2 was strongly associated with tumor grade; P4HA2 expression showed a weak negative correlation with HIF-2α expression. In cultured breast cancer cells, the immunohistological expression of P4H and HIF increased tovarious degrees under hypoxia, while P4H protein levels increased in a time-dependent manner. 　Conclusion: P4HA2 can be used as a marker of breast cancer grade and a prognostic factor. Differential expression of P4HA1 and P4HA2 was observed in an ischemic environment,suggesting that each may be affected by the type of collagen involved

Minimally invasive cardiac surgery via a right mini-thoracotomy

　Minimally invasive surgery, which has become very active outside the cardiovascular field, has recently come to the fore in this area. Then, procedures such as offpump coronary artery bypass grafts without extracorporeal circulation and stent grafts for treating aortic aneurysms have been frequently performed.　In cardiac surgery, as in other surgical fields, more and more surgeries that are less and less invasive have been introduced in recent years. Off-pump coronary artery bypass grafting has contributed to the development of these less invasive surgeries. For example, cardiac surgery utilizing a partial sternotomy was introduced as a way to better access the surgical location. However, minimally invasive cardiac surgery (MICS) through a right mini-thoracotomy, a portaccess cardiac surgery, is said to be trending recently because it avoids a sternotomy and has less bleeding and wound infection. All of these factors not only promote early recovery, but are also expected to have a positive impact on early discharge and the health care economy.　With surgeons and hospitals accumulating experience, MICS is being applied to more complex lesions and has begun to be used to treat the aortic valve in addition to the mitral valve. Off-the-job training and team building are also key factors for implementing a successful program. This type of port-access cardiac surgery is already beginning to be developed into a robotically assisted heart surgery by various facilities around the world

Les normes, comment?

La description normalisée des ressources d’enseignement et d’apprentissage requiert l’utilisation d’outils d’implantation conformes aux conventions d’un standard ou d’une norme internationale et un réseau d’entraide et d’accompagnement

脾動脈瘤３例の検討

今回当科で経験した脾動脈瘤３例について報告する．年齢は17歳から76歳（平均49.3歳）で、女性；１例、男性；２例であった．１例は破裂症例で緊急開腹，それ以外の２例は血管内治療を施行し,全て術後経過は良好であった．緊急開腹術を行った１例は２cm 未満の嚢状瘤であり，術前瘤径にとらわれず治療適応を考える必要がある．治療の第一選択として低侵襲な血管内治療を考慮する必要がある．We report 3 cases of splenic artery aneurysm (2 males,1 female; median age, 49.3 years; age range, 17-76 years).We performed splenectomy (included aneurysm) in emergency surgery for one ruptured case and performed endovascular therapy for two unruptured cases. The postoperative progress of all cases was satisfactory.Emergency case was saccular aneurysm under 2cm of size. Indication for treatment of intraabdominal aneurysm may be considered even in small size of aneurysm.All cases are still alive. It is necessary to take into account minimally invasive endovascular therapy in first-line

Skin Tube Reconstruction for Esophageal Defects due to Postoperative Complications: Applying a skin flap in esophageal resection and reconstruction

Numerous improvements and advances in operational methods and techniques have occurred in the area of reconstruction for esophageal cancer. Patients with thoracic esophageal cancer who have previously had a gastrectomy usually undergo reconstruction using the colon and small intestine. The incidence of organ necrosis is not necessarily low after reconstruction with those organs. Generally, the main types of skin flaps and musculocutaneous flaps used for cervical and other esophageal reconstructions are deltopectoral (DP) flaps, pedicled musculocutaneous latissimus dorsi flaps and free anteriolateral thigh flaps. This kind of reconstruction is low invasive, relatively simple, and also causes very few fatal post-operative complications. Therefore, it is considered to be an effective reconstruction choice for the following types of patients: poor risk patients, patients whose gastrointestinal (GI) tract cannot be used for their reconstruction for some reason, and patients having a second reconstruction due to complications caused by organ necrosis after their first GI tract reconstruction

Current Status and Future Potential of Robotic Surgery for Gastrointestinal Cancer

　Robotic surgery has built on innovations in areas such as medical engineering and optical technology. Laparoscopic surgery has been successfully adapted for gastric, colon, and rectal cancer surgeries over the past two decades with numerous clinical trials showing oncological results comparable to those of open surgery. These trials have also shown that the laparoscopic approach shortens postoperative recovery time and decreases complication rates. Another advantage of minimally invasive techniques for the resection of gastric, colon, and rectal cancers is improved visualization of the surgical field. Despite the near absence of tactile feedback, robotic surgery has overcome many of the challenges inherent in laparoscopic surgery through features such as 3D vision, stable magnification, EndoWrist instruments, physiological tremor filtering, and motion scaling. Robotic surgery is not yet widely used in esophageal cancer surgery or in a pancreaticoduodenectomy for pancreatic cancer due to anatomical difficulties and the lack of a suitable approach.　Comparative studies of robotic and laparoscopic surgery have shown similar results in terms of perioperative management, oncologic evaluation, and functional outcomes. However, it is also true that the high cost and lack of tactile feedback in robotic surgery are major limitations in terms of current robotic technology becoming the worldwide standard for minimally invasive surgery. The future of robotic surgery will require cost reduction, the development of new platforms and technologies, the creation and validation of curricula and virtual simulators, and confirmation through appropriate randomized controlled clinical trials

A Case of Cholesterol Crystal Embolization with Hemorrhagic Intestinal Ulcer

Cholesterol crystal embolization (CCE) is a rare systemic embolism caused　by formation of cholesterol crystals from atherosclerotic plaques. CCE usually occurs during　vascular manipulation such as vascular surgery or endovascular catheter manipulation, or　due to anticoagulation or thrombolytic therapy. We report a rare case of localized intestinal　ulcer with active hemorrhage caused by spontaneous CCE. An 83-year-old man with a history　of hypertension and diabetes was treated with a percutaneous coronary intervention (PCI)　for myocardial infarction. Melena occurred eight days after PCI. An abdominal computed　tomography revealed small intestinal ulcer, extravasation of the gastrointestinal tract and　bleeding in the abdominal cavity. The patient was diagnosed as bleeding from the small　intestinal ulcer, so an emergency laparotomy was performed. Partial resection of the small　intestine was performed. A histopathological examination indicated that small intestine　obstruction was caused by CCE. A histopathological examination indicated that small intestinal　obstruction was caused by CCE. Therefore, in cases of intestinal obstruction after vascular　manipulation, CCE should also be considered

Evaluation of intra-ductal cancer spread using contrast superb micro-vascular imaging (SMI) : a case report

Currently, breast conserving surgery has been adopted to treat more than half of all breast cancer patients in Japan. When performing breast-conserving surgery, an appropriate margin needs to be determined for radical cure. The resection volume influences the esthetic outcome, but a cancer-positive resection stump is also important risk factor of local recurrence. Additionally, the degree of cancer progression influences the surgical method, so understanding the appropriate resection margin is necessary for the surgeons. We report here on a 50- year old patient whose intra-ductal cancer progression was shown, as predicted, by contrast SMI (superb micro-vascular imaging). A one-cm size tumor mass was palpable with a clear boundary. B-mode ultrasound confirmed the presence of a breast duct towards the nipple from the tumor mass. Using contrast SMI, an accelerated blood flow was detected around the duct, which suggested intra-ductal progression. The pathological results also showed intra-ductal progression to the nipple from the tumor. Around the progression area, a meandering vessel was found and the vessel was able to be visualized by contrast SMI

Role of the expression of collagen prolyl-4-hydroxylase α subunits 1 and 2 in the development and prognosis of breast cancer

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