Delayed stomach necrosis in a patient with injured celiac artery branches after penetrating abdominal trauma

Injuries of the celiac artery and its branches are rare, but potentially lethal. Ligation of these arteries is performed to control significant hemorrhage. However, few reports have described the adverse effects of ligating these arteries.A 69-year-old woman with a self-inflicted stab wound was brought to our hospital. Her blood pressure could not be measured, therefore aortic cross-clamping was performed, and epinephrine was administered for resuscitation, an emergency laparotomy was performed, and the roots of splenic artery and common hepatic artery were ligated. The left gastric artery which was anomalous and arose directly from the aorta, was also injured and had to be ligated. Norepinephrine was required after the surgery. Enhanced computed tomography performed on hospital day 4 revealed a disrupted celiac artery. The patient developed gastric necrosis on hospital day 23 and, hence, underwent total gastrectomy was performed.The possibility of delayed stomach necrosis should be considered during the postoperative management of patients who undergo ligation of all of the celiac artery branches and experience global hypoperfusion after the surgery

Protective effects of p53-regulating agents against high-LET radiation-induced injury in mice

Radiation damage to normal tissues is one of the most serious concerns in radiation therapy, and the tolerance dose of the normal tissues limits the therapeutic dose to the patients. p53 is well known as a transcription factor closely associated with radiation-induced cell death. We recently demonstrated the protective effects of several p53-regulating agents against low-LET X- or γ-ray-induced damage: Sodium orthovanadate (vanadate) markedly rescued mice from bone marrow death following total-body X-irradiation through inhibition of p53 activity, and 5-chloro-8-quinolinol (5CHQ) effectively suppressed the intestinal death in the abdominally irradiated mice via modulation of p53 transactivation. Although it was reported that high-LET heavy ion radiation (> 85 keV/μm) could cause p53-independent cell death in some cancer cell lines, whether there is any radioprotective effect of the p53-regulating agents against the high-LET radiation injury in vivo is still unclear. In the present study we verified and confirmed the efficacy of these agents on bone marrow and intestinal damages induced by high-LET carbon-ion irradiation in mice. Vanadate dramatically improved 60-day survival rate in mice treated with total-body carbon-ion irradiation, indicating its effective protection of the hematopoietic system from radiation injury. 5CHQ slightly increased the survival rate after abdominal irradiation, suggesting the moderate relief of the intestinal damage. More detailed investigation is currently in progress to clarify the mechanisms involved in protecting the mice from high-LET radiation.\n国際セミナー・ワークショップ　”Technological Competency as Caring in the Health Sciences: A seminar and workshop”

Therapeutic Efficacy and Safety of Lenvatinib after Atezolizumab Plus Bevacizumab for Unresectable Hepatocellular Carcinoma

A total of 137 HCC patients treated with atezolizumab plus bevacizumab from October 2020 to September 2022 were enrolled. The median overall survival (OS) and progression-free survival (PFS) from the beginning of atezolizumab plus bevacizumab were 21.1 months (range, 18.8 months–not reached) and 10.5 months (range, 8.2–12.1 months), respectively. Fifty patients were diagnosed with progressive disease after atezolizumab plus bevacizumab. Of this group, 24 patients were administered lenvatinib, and the median OS and PFS from the beginning of lenvatinib were 15.3 months (range, 10.5 months–not reached) and 4.0 months (range, 2.5–6.4 months), respectively. The objective response rates based on the response evaluation criteria in solid tumors (RECISTs) criteria version 1.1 and modified RECISTs were 33.3% and 54.2%, respectively. There was no significant difference in the median serum alpha-fetoprotein level between before and after lenvatinib. In the multivariate analysis, Child–Pugh class A (hazard ratio 0.02, 95% confidence interval (CI) 0.02–0.76, p = 0.02) and intrahepatic tumor occupancy rate p < 0.01) were the significant factors for OS. There were some frequent adverse events (AEs) in patients treated with lenvatinib such as hypertension, fatigue, anorexia, proteinuria, and so on, but none directly caused death. In conclusion, lenvatinib after atezolizumab plus bevacizumab for unresectable HCC should be considered an effective treatment option