重症虚血肢に対して浅大腿動脈に対するremote endarterectomyおよび大伏在静脈を用いた後脛骨動脈バイパスを行った一例

重症虚血肢の外科的血行再建に際し，大伏在静脈が不良である場合にバイパスグラフト選択に苦慮することが多いが，我々は浅大腿動脈に遠隔血栓内膜摘除術（remote endarterectomy；RE）を行うことによりグラフト長補填が可能であった症例を経験したので報告する．症例は72 歳男性．右第一趾の爪下膿瘍を伴った下肢虚血で当科紹介となった．大腿部大伏在静脈は分岐が多く性状は不良であったため，右浅大腿動脈にremote RE を行い，その末梢側をin-flow としたin-situ バイパスを後脛骨動脈に行った．術後足趾の感染は治癒し，跛行症状も改善した．Bypass graft selection for surgical revascularization of critical limb ischemia is often difficult in cases where the great saphenous vein is inadequate. Herein, we report a case where we performed remote superficial femoral artery（SFA）endarterectomy, by which we adjusted thegraft length. A 72-year-old man with lower limb ischemia accompanied by subungual abscess on the right first toe was referred to our department. As the femoral great saphenous vein had many branches and its condition was poor, we performed remote right SFA endarterectomy followedby an in situ bypass to the posterior tibial artery, in which the distal side was used as an in-flow site. After the surgery, infection of the toe healed and the claudication improved

Long-term results of a randomized controlled trial comparing neoadjuvant Adriamycin, cisplatin, and 5-fluorouracil vs docetaxel, cisplatin, and 5-fluorouracil followed by surgery for esophageal cancer (OGSG1003)

Sugimura, K, Yamasaki, M, Yasuda, T, et al. Long‐term results of a randomized controlled trial comparing neoadjuvant Adriamycin, cisplatin, and 5‐fluorouracil vs docetaxel, cisplatin, and 5‐fluorouracil followed by surgery for esophageal cancer (OGSG1003). Ann. Gastroenterol. Surg. 2020; 00: 1– 8. https://doi.org/10.1002/ags3.12388

Influence of genetic factors on the ephedrine alkaloid composition ratio of Ephedra plants

We investigated the ephedrine alkaloid [(-)-ephedrine and (+)-pseudoephedrine] composition ratio of a crude Chinese herbal drug described in the Japanese Pharmacopoeia \u27Ephedra herb (Chinese name: Mahuang)\u27. There were marked changes in the alkaloid composition ratio of wild plants in areas where both male and female clusters coexisted. However, in genetically homogeneous areas with the growth of male or female clusters alone, all of the coefficients of the regression lines were positive, but each gradient varied. This suggests that the alkaloid composition ratio has a clear tendency in each individual. Based on this, we cultivated individuals for vegetative propagation, and evaluated the alkaloid content ratio. Those propagated by separating the roots showed a specific tendency regardless of the cultivation area (Wakayama, Tanegashima). Those propagated by separating the herbaceous stem showed a specific tendency regardless of the soil or harvest time. In addition, we surveyed the (-)-ephedrine content ratio of 3- to 6-year-old strains. There was a high positive correlation coefficient between the previous and subsequent years. These findings suggest that the ephedrine alkaloid composition ratio of Ephedra herb depends on genetic factors, but not on environmental factors or the growth period

Calcium sparks enhance the tissue fluidity within epithelial layers and promote apical extrusion of transformed cells

In vertebrates, newly emerging transformed cells are often apically extruded from epithelial layers through cell competition with surrounding normal epithelial cells. However, the underlying molecular mechanism remains elusive. Here, using phospho-SILAC screening, we show that phosphorylation of AHNAK2 is elevated in normal cells neighboring RasV12 cells soon after the induction of RasV12 expression, which is mediated by calcium-dependent protein kinase C. In addition, transient upsurges of intracellular calcium, which we call calcium sparks, frequently occur in normal cells neighboring RasV12 cells, which are mediated by mechanosensitive calcium channel TRPC1 upon membrane stretching. Calcium sparks then enhance cell movements of both normal and RasV12 cells through phosphorylation of AHNAK2 and promote apical extrusion. Moreover, comparable calcium sparks positively regulate apical extrusion of RasV12-transformed cells in zebrafish larvae as well. Hence, calcium sparks play a crucial role in the elimination of transformed cells at the early phase of cell competition