80歳以上の高齢者膵癌に対する膵切除の意義

Background: There is increasing need to evaluate the surgical indication of pancreatic cancer in very elderly patients. However, the available clinical data are limited, and the optimal treatment is still controversial. The aim of this study was to evaluate the benefit of pancreatic resection in pancreatic cancer patients over the age of 80. Methods: Between 2005 and 2012, 26 octogenarian patients who received pancreatic resection and 20 who received chemotherapy for pancreatic cancer were retrospectively reviewed. Clinicopathological factors, chemotherapy administration status, and survival were compared. Univariate and multivariate analysis of prognostic factors for survival was performed. Results: Postoperative major complication rate was 8%, with no mortality. The one-year survival rate and median survival time of the surgery and chemotherapy groups were 50% and 45%, and 12.4 months and 11.7 months, respectively (P = 0.263). Of the 26 resected cases, 6 completed the planned adjuvant chemotherapy treatment course. The median survival time of those 6 completed cases was significantly longer than that of the 20 not completed cases (23.4 versus 10.0 months, P = 0.034). Furthermore, a multivariate analysis of the 26 resected cases showed that distant metastasis (HR 3.206, 95%CI 1.005-10.22, P = 0.049) and completion of the planned adjuvant therapy (HR 4.078, 95%CI 1.162-14.30, P = 0.028) were independent prognostic factors of surgical resection. Conclusions: Surgical resection was safe, but not superior to chemotherapy for pancreatic cancer in octogenarians. In the very elderly, only selected patients may benefit from pancreatic resection.博士（医学）・乙第1513号・令和3年12月21日Copyright © 2015 IAP and EPC. Published by Elsevier, a division of RELX India, Pvt. Ltd. All rights reserved

IL-12 and IL-18 Induction and Subsequent NKT Activation Effects of the Japanese Botanical Medicine Juzentaihoto

In this study, we first measured some cytokine concentrations in the serum of patients treated with Juzentaihoto (JTT). Of the cytokines measured interleukin (IL) -18 was the most prominently up-regulated cytokine in the serum of patients under long term JTT administration. We next evaluated the effects of JTT in mice, focusing especially on natural killer T (NKT) cell induction. Mice fed JTT were compared to control group ones. After sacrifice, the liver was fixed, embedded and stained. Transmission electron microscope (TEM) observations were performed. Although the mice receiving the herbal medicine had same appearance, their livers were infiltrated with massive mononuclear cells, some of which were aggregated to form clusters. Immunohistochemical staining revealed that there was abundant cytokine expression of IL-12 and IL-18 in the liver of JTT treated mice. To clarify what the key molecules that induce immunological restoration with JTT might be, we next examined in vitro lymphocyte cultures. Mononuclear cells isolated and prepared from healthy volunteers were cultured with and without JTT. Within 24 hours, JTT induced the IL-12 and IL-18 production and later (72 hours) induction of interferon (IFN)-gamma. Oral administration of JTT may induce the expression of IL-12 in the early stage, and IL-18 in the chronic stage, followed by NKT induction. Their activation, following immunological restoration could contribute to anti-tumor effects

Rupture and Rhythm: A Phenomenology of National Experiences

This article investigates how people make sense of ruptures in the flow of everyday life as they enter new experiential domains. Shifts in being-in-time create breaks in the natural attitude that offer the opportunity to register national—or, for example, religious, gender, or class—experiences. People interpret ruptures in perception and proprioception by drawing connections with domains in which similar or contrasting kinds of disruption are evident. Normalizing the transition, rhythm—as both cadence and overall flow—helps people adjust to new circumstances, align action, and smooth subsequent ruptures. Based on extensive qualitative fieldwork, I examine the specific case of how novice and experienced tea ceremony practitioners in Japan move into, interpret, and normalize action within tea spaces

Immunohistochemical Comparison of Ontogenic Development of Bone Marrow Hematopoiesis in Two Different Ossification Systems

It is well known that the body skeleton is formed by two different types of ossification systems, endochondoral and intramembranous ossification. Bone marrow is the main site of active hematopoiesis after the formation of the bone marrow cavities. However, it is unclear whether the hematopoiesis in the bone marrow of two types of ossification is regulated by the same system or not. In this study, we focused on the ontogenic development of bone marrow hematopoiesis in two different ossification systems using mouse humeral bones and palatal process of maxillary bones. Immunohistochemical and RT-PCR analyses were performed to examine the development of hematopoiesis and the expression of cytokines related to hematopoiesis in the forming bone marrow (16-days gestation stage to 1-day postnatal stage). Immunohistochemical studies showed the sequential difference of hematopoiesis between two different ossification systems. In humeral bone marrow, granulopoiesis appeared first at E16, followed by erythropoiesis from E17. On the contrary, erythropoiesis preceded one day in the maxillary bone marrow at E18, one day before the detection of granulopoiesis. G-SCF and GM-CSF were expressed at every examined stage in both types of bones while M-CSF was not expressed in the humeral bone marrow at E16. Erythropoietin was detetcted in the endothelial cells and its expression was coincident with the onset of erythopoiesis. These results suggest the time kinetic and sequential differences of hematopoiesis in two different ossification systems, which might relate to the differences of hematopoietic microenvironment