Atrial tachycardia caused by a superior vena cava fibrillation with conduction block

AbstractAT caused by SVC fibrillationHere, we report a case of a 62-year-old man with a history of incessant atrial tachycardia (AT) for several years. An electrophysiological study revealed rapid and irregular activity in the superior vena cava (SVC), but the surface 12-lead electrocardiogram (ECG) exhibited a relatively regular AT (atrial cycle length=240ms). CARTO mapping of the right atrium (RA) demonstrated that the earliest atrial activation occurred at the posterior septum of the upper RA (the SVC–RA junction). Intravenous administration of 20mg adenosine triphosphate (ATP) led to an acceleration of the SVC–RA conduction up to 1:1 conduction, and the atrial cycle length decreased, consequently converting the AT to transient atrial fibrillation (AF). Application of single radiofrequency energy at the earliest atrial activation site during tachycardia terminated the AT and achieved isolation of the SVC from the RA, despite the continued presence of fibrillation in the SVC. We speculated that SVC fibrillation with spontaneous conduction block at the SVC–RA junction was the cause of this AT

Computed tomography texture analysis for the prediction of lateral pelvic lymph node metastasis of rectal cancer

Background: This study aimed to investigate the usefulness of computed tomography (CT) texture analysis in the diagnosis of lateral pelvic lymph node (LPLN) metastasis of rectal cancer. Methods: This was a retrospective cohort study of 45 patients with rectal cancer who underwent surgery with LPLN dissection at Tokushima University Hospital from January 2017 to December 2021. The texture analysis of the LPLNs was performed on preoperative CT images, and 18 parameters were calculated. The correlation between each parameter and pathological LPLN metastasis was evaluated. The texture parameters were compared between pathologically metastasis-positive LPLNs and metastasis-negative LPLNs. Results: A total of 40 LPLNs were extracted from 25 patients by preoperative CT scans. No LPLNs could be identified in the remaining 19 patients. Eight of the 25 patients had pathologically positive LPLN metastasis. Extracted LPLNs were analyzed by the texture analysis. Pathologically metastasis-positive LPLNs had significantly lower mean Hounsfield unit, gray-level co-occurrence matrix (GLCM) energy, and GLCM Entropy_log2 values, and a significantly larger volume than pathologically metastasis-negative LPLNs. Multivariate analysis revealed that the independent predictive factors for LPLN metastasis were volume (a conventional parameter) (odds ratio 7.81, 95% confidence interval 1.42–43.1, p value 0.018) and GLCM Entropy_log2 (a texture parameter) (odds ratio 12.7, 95% confidence interval 1.28–126.0, p value 0.030). The combination of both parameters improved the diagnostic specificity while maintaining the sensitivity compared with each parameter alone. Conclusion: Combining the CT texture analysis with conventional diagnostic imaging may increase the accuracy of the diagnosis of LPLN metastasis of rectal cancer

Neutrophil-lymphocyte ratio in sleeve gastrectomy

Purpose : The aim was to investigate the impact of the neutrophil-lymphocyte ratio (NLR) in sleeve gastrectomy (SG). Methods : 15 obese patients were enrolled in this study ; mean body weight (BW) 127.5kg ; mean body mass index (BMI) 46.7kg / m2. 10 of these were diabetics who underwent a SG. The impact of the pre-operative NLR on the percentage of excess weight loss (%EWL) and remission of diabetes 1 year post-operative were examined. Results : The %EWL at 1 year post-operative were 46.3%. Improvements were also evident in the diabetes at 1 year post-operative : complete remission (CR) 40%, partial remission (PR) 20% and Improve 40%. Comparing pre-operative NLR in %EWL < 50% and ≧ 50% in 1 year post-operative, < 50% was 2.64 and ≧ 50% was 2.03. The NLR in CR and PR was significantly lower than that in Improve. Conclusions : The pre-operative NLR may be a predictive marker of weight loss and improving diabetes after SG

BLUE LED FOR COLON CANCER AND CAFs

Irradiation with a specific wavelength of light using light‑emitting diodes (LEDs) has various effects on cells and organisms. Recently, the antitumor effects of visible blue light on tumor cells were reported; however, the mechanism and effects on the tumor microenvironment remain unclear. Human colon cancer cells (HCT‑116) were injected into the rectal wall of nude mice. Tumors were irradiated with a 465‑nm LED light at 30 mW/cm2 for 30 min. Tumor volumes and the expression levels of opsin 3 (Opn3), autophagy‑related factors, cancer‑associated fibroblast (CAF) markers, and programmed cell death 1‑ligand (PD‑L1) were measured. Additionally, human intestinal fibroblasts were cultured in HCT116‑conditioned medium (CM) to prepare CAFs. CAFs were divided into an LED group and a control group, and the effect of the LED light on CAF activation in colon cancer cells was examined. Irradiation with blue LED light suppressed tumor growth; Opn3 expression was localized to the cell membrane in the LED group. Irradiated tumors exhibited increased autophagy‑related gene expression. Furthermore, in the LED group, TGF‑β and α‑SMA expression levels in the fibroblasts were decreased. Regarding CAFs, α‑SMA and IL‑6 expression levels were decreased in the LED group. HCT‑116 cells cultured in CAF‑CM with LED irradiation showed no enhanced migration or invasion. In the HCT‑116 cells cultured in CM of CAFs irradiated with LED, the relative increase in PD‑L1 expression was lower than that noted in the CAF‑CM without LED irradiation. Blue LED light may have a direct antitumor effect on colon cancer and also an inhibitory effect on CAFs

Impact of frailty in elderly GC patients

Background : Frailty plays a crucial role in cancer patients who have received surgery in this recent aging society. We aimed to investigate frailty as a prognostic factor in elderly gastric cancer (GC) patients who underwent curative gastrectomy. Methods : We analyzed 86 elderly (over 75 years old) GC patients who underwent curative gastrectomy. Patients were assigned to two groups ; frailty group (n = 29) and no-frailty group (n = 57). Clinicopathological values were compared between the two groups. Results : The OS rate of the frailty group was significantly poorer than that of the no-frailty group (5-yr OS rate ; frailty group 52.49% vs. no-frailty group 74.87%, p < 0.05). Multivariate analysis of the OS showed that frailty tended to be significant prognostic factor (p = 0.09). The DFS rate of the frailty group was significantly poorer than that of the no-frailty group (5-yr DFS rate ; frailty group 42.30% vs. no-frailty group 71.55%, p < 0.05). Multivariate analysis of the DFS showed that frailty tended to be significant prognostic factor (p = 0.14). Conclusion : We identified the clinical impact of frailty prognostic factor for elderly GC patients who underwent gastrectomy

LG / RG for AGC following chemotherapy

Purpose : This study aimed to investigate the short-term outcomes of laparoscopic gastrectomy / robotic gastrectomy after chemotherapy in patients with advanced gastric cancer and compare these outcomes with those of open gastrectomy. Methods : Fifty patients who underwent radical gastrectomy for advanced gastric cancer after chemotherapy between 2007 and 2021 were retrospectively analyzed. The patients were divided into two groups : the laparoscopic gastrectomy / robotic gastrectomy (n = 11) and open gastrectomy (n = 39) groups. The short-term outcomes of these procedures were subsequently examined. Results : The laparoscopic gastrectomy / robotic gastrectomy group had significantly shorter hospital stays and lower intraoperative blood loss than the open gastrectomy group. The overall complication rates were 12.8% (5 of 39 patients) and 0% (0 of 11 patients) in the open gastrectomy and laparoscopic gastrectomy / robotic gastrectomy groups, respectively (P = 0.1). Conclusions : Laparoscopic gastrectomy / robotic gastrectomy may be a surgical option after chemotherapy for patients with advanced gastric cancer

Risk factors for postoperative ileus after diverting loop ileostomy closure

Background: Postoperative ileus is one of the most common complications after diverting loop ileostomy closure. Some reports have investigated the risk factors for postoperative complications or ileus after ileostomy closure; however, these studies did not evaluate the index surgery sufficiently. In this study, we evaluated the risk factors, including the details of the index surgery, for ileus after diverting ileostomy closure. Methods: This was a retrospective study of patients who underwent ileostomy closure following index surgery for rectal cancer. Patients who developed postoperative ileus [POI (+)] and patients who did not [POI (−)] after ileostomy closure were compared. Results: Sixty-eight patients were evaluated and were divided into two groups: POI (+) (n = 11) and POI (−) (n = 57), and the groups were compared. There were no significant differences in the details of the index surgery, operative procedure, transanal total mesorectal excision, lateral lymph node dissection, operating time, or blood loss. The incidence of Clavien–Dindo grade ≥ III complications and adjuvant chemotherapy after index surgery were significantly higher in the POI (+) group. Conclusions: The incidence of Clavien–Dindo grade ≥ III complications and adjuvant chemotherapy after index surgery may increase the risk of postoperative ileus after ileostomy closure

Role of IDO expression in patients with locally advanced rectal cancer treated with preoperative chemoradiotherapy

Background: The role of the immune system in locally advanced rectal cancer (LARC) following preoperative chemoradiotherapy (CRT) has been widely investigated in recent years. This study examined the prognostic significance of indoleamine-pyrrole 2,3-dioxygenase (IDO) expression in patients with LARC who received preoperative CRT. Methods: Ninety patients with LARC who underwent preoperative CRT and curative resection were enrolled. IDO and programmed death-ligand 1 (PD-L1) expression was evaluated by immunohistochemistry. Results: Clinicopathological factors did not significantly differ between patients with positive or negative IDO expression, excluding the correlation of positive IDO expression with better tumor differentiation (p = 0.02). IDO expression was not associated with pathological response (p = 0.44), but it was associated with PD-L1 expression. The 5-year overall survival (OS) rate was significantly worse in the IDO-positive group than in the IDO-negative group (64.8% vs. 85.4%, p = 0.02). Univariate analysis identified IDO and PD-L1 expression (p = 0.02), surgical procedure (p = 0.01), final pathological stage (p = 0.003), lymph node metastasis (p < 0.001), and lymphatic invasion (p = 0.002) as significant prognostic factors for OS. Multivariate analysis revealed that IDO expression (HR: 7.10, p = 0.0006), surgical procedure (HR: 5.03, p = 0.01), lymph node metastasis (HR: 2.37, p = 0.04) and lymphatic invasion (HR: 4.97, p = 0.01) were independent prognostic indicators. Disease-free survival was not correlated with IDO or PD-L1 expression. Conclusions: IDO expression in patients with LARC who received preoperative CRT could be a potential prognostic indicator. IDO expression could be a useful marker for specifying individual treatment strategies in LARC