Laparoscopic extra-abdominal suturing technique for the repair of Larrey’s diaphragmatic hernia using the port closure needle (Endo Close®): A case report

AbstractIntroductionMorgagni’s or Larrey’s diaphragmatic hernias are relatively uncommon. If the defect is too large for primary closure, the use of a mesh is inevitable. Although primary closure is adaptable for relatively small defects, it is difficult to suture the hernial orifice in which the anterior rim is absent. Herein, we present the case of a patient with Larrey’s diaphragmatic hernia that was easily and securely repaired using the recently developed laparoscopic extra-abdominal suturing technique via the port closure needle (Endo Close®; Medtronic, Minneapolis, USA).Presentation of caseAn 89-year-old woman complaining of vomiting was transferred to our hospital. Computed tomography scan showed Larrey’s diaphragmatic hernia. Laparoscopic repair was performed after gastric decompression. We diagnosed Larrey’s hernia on the left side of the falciform ligament. The transverse colon was herniated through the defect. Since the hernial defect was located below the substernal space, there was no tissue to stitch at the anterior rim of the hernial orifice. We performed the extra-abdominal suturing technique, suturing the posterior rim of the hernia to the full thickness of the anterior abdominal wall using the port closure needle (Endo Close®) without the need for a mesh. The patient was discharged on the 8th postoperative day. There was no evidence of recurrence at 8 months postoperatively.DiscussionThe recently developed extra-abdominal suturing technique using Endo Close® to suture the full thickness of the anterior abdominal wall achieved secure mattress suture and easy extra-abdominal tying.ConclusionThis method may be useful in terms of easiness and security of suture

The ubiquitination-deubiquitination cycle on the ribosomal protein eS7A is crucial for efficient translation

Ubiquitination is a major post-translational modification of ribosomal proteins. The role of ubiquitination in the regulation of ribosome functions is still being elucidated. However, the importance of ribosome deubiquitination remains unclear. Here, we show that the cycle of ubiquitination and deubiquitination of the 40S ribosome subunit eS7 is important for efficient translation. eS7 ubiquitination at lysine 83 is required for efficient protein translation. We identified Otu2 and Ubp3 as the deubiquitinating enzymes for eS7. An otu2Δubp3Δ mutation caused a defect in protein synthesis. Ubp3 inhibited polyubiquitination of eS7 in polysomes to keep eS7 in a mono-ubiquitinated form, whereas Otu2 was specifically bound to the free 40S ribosome and promoted the dissociation of mRNAs from 40S ribosomes in the recycling step. Our results provide clues for understanding the molecular mechanism of the translation system via a ubiquitination-deubiquitination cycle

Pathological significance and prognostic role of microvessel density, evaluated using CD31, CD34, and CD105 in prostate cancer patients after radical prostatectomy with neoadjuvant therapy

BACKGROUND. Neoadjuvant hormonal therapy (NHT) is performed to improve the outcome in organ-confined prostate cancer. However, there is little information regarding the relationship between angiogenesis and NHT. The aim of this study was to identify a suitable method to evaluate the angiogenic status of tissue, and to determine the prognostic value of this method for biochemical recurrence in patients who had undergone radical prostatectomy after NHT.METHODS. We analyzed 108 formalin-fixed specimens from patients treated by radical prostatectomy. NHT was administered in 48 patients (52.9%) and 60 patients who had a similar Gleason score and pT stage were selected as a non-NHT treated control group. Microvessel density (MVD) was measured using anti-CD31, anti-CD34, and anti-CD105 antibodies. The expressions of vascular endothelial growth factor (VEGF)-A and thrombospondin (TSP)-1 were also evaluated by immunohistochemistry. The prognostic value of CD31-, CD34-, and CD105-MVD for biochemical recurrence was investigated.RESULTS. The mean/SD of CD105-MVD in the NHT group (13.3/4.7) was significantly (P<0.001) lower than that in the non-NHT group (125.8/7.3). In the NHT group, CD105-MVD was associated with pT stage and it was positively correlated with VEGF-A expression (r=0.56, P<0.001) and negatively correlated with TSP-1 expression (r=0.42, P=0.003). CD105-MVD was identified as a significant predictor of biochemical recurrence (BCR) in patients treated with NHT (log rank test, P<0.001). Although CD31- and CD34-MVD were significantly associated with pT stage or Gleason score in non-NHT group, they were not associated with pathological features and BCR in NHT group.CONCLUSIONS. Our results indicate that CD105-MVD reflects the angiogenic conditions in prostate cancer tissues treated with NHT. CD105-MVD was also identified as a significant and independent predictor of biochemical recurrence in prostate cancer patients who underwent radical prostatectomy with NHT

Perehdyttämisopas Yläristin Pysäkille

Opinnäytetyöni tarkoituksena oli suunnitella ja toteuttaa sähköisessä muodossa oleva perehdyttämisopas Yläristin pysäkin henkilökunnan ja opiskelijoiden käyttöön. Yläristin pysäkki on Pieksämäen kaupungin ylläpitämä 8-paikkainen päihdekuntoutus- ja asumispalveluyksikkö, jonka toiminta kuuluu mielenterveys- ja päihdepalveluiden piiriin. Toiminta perustuu tiimi- ja verkostoyhteistyöhön sekä yksilöhoitoon yhteisöhoidollisin menetelmin, ja sen tavoitteena on tukea asiakkaan päihteettömyyttä ja olla mukana muutosprosessin eri vaiheissa. Henkilökuntaan kuuluu yksi sairaanhoitaja ja kolme lähihoitajaa. Lisäksi Yläristin pysäkillä on vuosittain useita sairaanhoitaja-, sosionomi- ja lähihoitajaopiskelijoita suorittamassa opintoihin kuuluvia harjoittelujaksoja. Tavoitteena opinnäytetyölläni oli tukea työyhteisön hyvinvointia ja yhtenäisten toimintamallien toteutumista perehdyttämisoppaan avulla. Opinnäytetyön teoreettinen viitekehys käsittelee perehdyttämistä ja siihen liittyviä tekijöitä – perehdyttämisen sisältöä, perehdyttäjiä ja perehdyttämisprosessia kokonaisuutena. Aiempaa tutkimustietoa hoitoalan perehdyttämisestä ja sen hyödyistä löytyi suomen kielellä melko niukasti. Tutkimusten mukaan hyvällä perehdyttämisellä on merkittäviä vaikutuksia muun muassa työhön sitoutumiseen ja työssä viihtymiseen. Opinnäytetyöprosessi käynnistyi keväällä 2015 työharjoitteluni aikana ja eteni pääosin ennalta suunnitel-lun aikataulun mukaisesti. Toimeksiantajan edustajat olivat aktiivisesti mukana tuotteen kehittämisessä sekä koko opinnäytetyöprosessissa. Tuotteen kehitysvaiheessa toimeksiantajan edustajia haastateltiin tarpeista ja toiveista perehdyttämisoppaaseen liittyen, näin kokoon saatiin mahdollisimman kattava ja sisällöltään toimeksiantajan tarpeita vastaava tuote. Viimeistelyvaiheessa toteutettiin toinen haastattelu, jossa toimeksiantajan edustajat arvioivat tuotteen ja pohtivat sen jatkokehitysmahdollisuuksia. Valmis tuote, eli perehdyttämisopas on yhteisymmärryksessä toimeksiantajan ja koulun edustajien kanssa salattu sen sisältämien yksityiskohtaisten ja arkaluontoisten tietojen vuoksi.The purpose of this thesis was to design and create a digital orientation guide for the employees and students working at Yläristin Pysäkki. Yläristin Pysäkki is a rehabilitation and accommodation unit, which is maintained by the City of Pieksämäki. It has 8 places and operates under Pieksämäki mental and sub-stance abuse services. The operations are based on co-operation in teams and networks. Collaborative methods are used for supporting individual care. The aim in the unit is to support the clients’ abstinence and take part in the different stages of their change process. There a registered nurse and three practical nurses working in the unit. In addition, every year there are several registered and practical nurse students as well as students from social services programmes performing their practical training. The goal of the digital guide was to support the wellbeing of the personnell and harmonise and enable coherent procedures. The theoretical framework of the study discusses orientation and the factors related to it – the content of orientation, mentors and the orientation process as a whole. There were only a few previous studies avail-able on orientation in the Finnish language. According to the studies proper orientation has significant impact on employee commitment and satisfaction. The process of the thesis started in spring 2015 during my practical training and it progressed according to plan. The representatives of Yläristin Pysäkki took active part in the development phase as well as sup-ported me during the whole process. During the design phase the representatives of Yläristin Pysäkki were interviewed about their needs and hopes regarding the orientation guide. With this information it was possible to create a comprehensive product, which would fulfil their needs. During the finishing phase a second set of interviews was conducted for evaluation by the unit representatives. Further development possibilities were also considered. The final product itself, the digital orientation guide for Yläristin Pysäkki has been classified as Company Confidential due to its detailed and sensitive content.Opinnäytetyö sisältää perehdyttämisoppaan (30 sivua), josta julkaistu vain sisällysluettel

Use of Material Safety Data Sheets at Workplaces Handling Harmful Substances in Okayama, Japan

Abstract: Use of Material Safety Data Sheets at Workplaces Handling Harmful Substances in Okayama, Japan: Akihiko SEKI, et al. Department of Public Health, Okayama University Medical School-In April 2000, the revised Industrial Safety and Health Law, which prescribes the creation and issue of material safety data sheets (MSDSs), was enforced in Japan. Before the enforcement, we conducted a survey relating to the use of MSDSs in hazardous workplaces in Okayama Prefecture, Japan. We sent questionnaires to all workplaces possibly using hazardous chemicals, and answers from 422 workplaces, where hazardous chemicals were used but not produced, were analyzed. One-third of the workplaces did not request MSDSs at the time of chemical transfer. In more than half of the workplaces, MSDSs were not posted or kept. The main reason for such lack of use or misuse of the MSDS system was a lack of knowledge and understanding of the system. In addition, half of the respondents considered that MSDS documents were unsatisfactory because of the difficult words used in them. These two problems, i.e., a lack of knowledge and understanding of the MSDS system, and the use of difficult words in the documents, should be remedied in order for the MSDS system to be implemented effectively and thereby protect workers from the harmful effects of chemicals. (J Occup Health 2001; 43: 95-100

Factors affecting prognosis of idiopathic interstitial pneumonia.

&#60;P&#62;Idiopathic interstitial pneumonia (IIP) is a progressive and often fatal pulmonary disorder, and evaluating the prognosis of patients with IIP has never been sufficient. Accordingly, factors including clinical features, laboratory data, cellular components in bronchoalveolar lavage (BAL) fluid and response to corticosteroid therapy were analyzed in 35 patients with IIP whose median age of respiratory onset was 60 years (range; 37-77 years). Nineteen patients (54.3%) were in the active stage of IIP and 16 of them were treated with corticosteroids. Significant prognostic factors were the neutrophil percentage in BAL fluid, interstitial shadows on chest radiograph, pulmonary function, blood oxygen level, grade of dyspnea, and disease activity at the initial examination. Patients in the active stage showed higher proportions of neutrophils and eosinophils in BAL fluid than those in the non-active stage. Despite corticosteroid therapy, the survival of patients in the active stage was significantly shorter than those in the non-active stage. Fifty percent of the patients treated with corticosteroids were regarded as responders at 1 month after the initiation of therapy; however, there was no significant difference between responders and non-responders in terms of survival time. In conclusion, disease activity and neutrophils in BAL fluid may be important predictors of the prognosis of IIP.&#60;/P&#62;</p

The apelin‑apelin receptor signaling pathway in fibroblasts is involved in tumor growth via p53 expression of cancer cells

Cancer-associated fibroblasts (CAFs) are pivotal in tumor progression. TP53-deficiency in cancer cells is associated with robust stromal activation. The apelin-apelin receptor (APJ) system has been implicated in suppressing fibroblast-to-myofibroblast transition in non-neoplastic organ fibrosis. The present study aimed to elucidate the oncogenic role of the apelin-APJ system in tumor fibroblasts. APJ expression and the effect of APJ suppression in fibroblasts were investigated for p53 status in cancer cells using human cell lines (TP53-wild colon cancer, HCT116, and Caco-2; TP53-mutant colon cancer, SW480, and DLD-1; and colon fibroblasts, CCD-18Co), resected human tissue samples of colorectal cancers, and immune-deficient nude mouse xenograft models. The role of exosomes collected by ultracentrifugation were also analyzed as mediators of p53 expression in cancer cells and APJ expression in fibroblasts. APJ expression in fibroblasts co-cultured with p53-suppressed colon cancer cells (HCT116sh p53 cells) was significantly lower than in control colon cancer cells (HCT116sh control cells). APJ-suppressed fibroblasts treated with an antagonist or small interfering RNA showed myofibroblast-like properties, including increased proliferation and migratory abilities, via accelerated phosphorylation of Sma- and Mad-related protein 2/3 (Smad2/3). In addition, xenografts of HCT116 cells with APJ-suppressed fibroblasts showed accelerated tumor growth. By contrast, apelin suppressed the upregulation of phosphorylated Smad2/3 in fibroblasts. MicroRNA 5703 enriched in exosomes derived from HCT116sh p53 cells inhibited APJ expression, and inhibition of miR-5703 diminished APJ suppression in fibroblasts caused by cancer cells. APJ suppression from a specific microRNA in cancer cell-derived exosomes induced CAF-like properties in fibroblasts. Thus, the APJ system in fibroblasts in the tumor microenvironment may be a promising therapeutic target.Saiki H., Hayashi Y., Yoshii S., et al. The apelin‑apelin receptor signaling pathway in fibroblasts is involved in tumor growth via p53 expression of cancer cells. International Journal of Oncology 63, 139 (2023); https://doi.org/10.3892/ijo.2023.5587