ワカテ ショウニ ゲカイ ノ ECFMG certificate シュトク エノ チョウセン : ベイコク ショウニ ゲカ リンショウ リュウガク オ メザシテ

Recently, many Japanese pediatric surgeons undertake clinical training abroad, especially in the United States of America (USA) which is one of the most attractive country for advanced clinical training. Since the Japanese government introduced a 2-year mandatory residency program in 2004, it has become more and more important for busy Japanese residents to spent time efficiently in order to achieve ECFMG (Educational Commission For Foreign Medical Graduates) certification. ECFMG certification requires residents to pass both Step 1 and 2 of the United States Medical License Examination (USMLE). It is especially difficult to pass step2 CS (Clinical Skills) for many Japanese who are unfamiliar with the English language. For example, one of authors started to study for the USMLE in the 6th grade of the Japanese Medical School (MS4), passed step1 and step2 CK (Clinical Knowledge) during the 2-year mandatory intensive rotating residency program, and passed Step2 CS on the 3rd attempt during the general surgery residency program. This shows that a Japanese examinee can pass the ECFMG certificate even during a busy rotating residency program

ショウニ ノ タンカン カクチョウガタ スイ タンカン ゴウリュウ イジョウ セツジョレイ ニ ハツガン カンレン イデンシ HDAC ガ コウハツゲン シテイタ 1レイ

Pancreaticobiliary maljunction（PBM）is the congenital malformation that the junction of the pancreatic and bile ducts is located outside of the duodenal wall anatomically, so sphincter function preventing to mix the bile and pancreatic juice does not act. In PBM, the mutual reflux of bile and pancreatic juice induces various diseases and becomes the cause of biliary tract cancer generation. PBM is divided into PBM with the biliary dilatation and PBM without the biliary dilatation. From the perspective of carcinogenesis, surgery to separate the pancreatic juice and bile by excision of extrahepatic biliary tract and hepaticojejunostomy is commonly performed in the former, the treatment of the latter is controversial, for instance ; the only cholecystectomy should be performed and excision of extrahepatic biliary tract is unnecessary or excision of extrahepatic biliary tract and hepaticojejunostomy should be done. In addition, histone acetylation and histone deacetylation is one of the important regulatory mechanism of gene transcription, the error of the balance between histone acetyltransferase（HAT）and histone deacetylase（HDAC）leads to carcinogenesis. In other words, HDAC has a carcinogenic potential. Overexpression of HDAC was found in the both resected gallbladder and bile duct mucosa of infant PBM patient with the biliary dilatation performed the excision of extrahepatic biliary tract and hepaticojejunostomy in our department. Appropriate treatment for PBM has not been established yet, but even infant case with PBM has carcinogenesis potential just like this case. In conclusion, further accumulation of cases including PBM without the biliary dilatation was thought to be essential though the excision of extrahepatic biliary tract and hepaticojejunostomy still seems to be required for infant PBM patient with the biliary dilatation

High expression of cancer stem cell markers in cholangiolocellular carcinoma

Purpose Cholangiolocellular carcinoma (CLC) is an extremely rare malignant liver tumor. It is thought to originate from the ductules and/or canals of Hering, where hepatic stem cells (HpSC) are located, but there are few reports on cancer stem cell markers in CLC. Thus, we evaluated the significance of cancer stem cell markers, including CD133, CD44, and EpCAM, in CLC. Methods The subjects of this study were three patients with CLC and one patient with an intermediate type of combined hepatocellular cholangiocarcinoma (CHC). The cancer cell markers, CK7, CK19, and EMA, were evaluated immunohistochemically. Results Histological examination of the CLC revealed morphologically cholangiolar features and immunohistochemical examination revealed positivity for CD133, CD44, and EpCAM. On the other hand, in the intermediate type of CHC, only CD44 was positive, whereas CD133 and EpCAM were negative. Conclusion CLC may have stronger features derived from HpSCs than an intermediate type of CHC

Effect of histone deacetylase inhibitor in combination with 5-fluorouracil on pancreas cancer and cholangiocarcinoma cell lines

Background : Histone deacetylase (HDAC) is well known to be associated with tumorigenesis through epigenetic regulation, and its inhibitors (HDACIs) induce differentiation and apoptosis of tumor cells. We examined the therapeutic effects of valproic acid (VPA, a HDACI) with a combination of 5-fluorouracil (5-FU) in vitro. Methods : A human pancreas cancer cell line (SUIT-2) and a cholangiocarcinoma cell line (HuCCT1) were used. Cell viabilities were evaluated by a cell proliferation assay. We determined the anticancer effects of VPA combined with 5-FU in these cell lines. Results : Pancreas cancer (SUIT-2) : No effect of 5-FU (1.0 μM) was observed, but 17% and 30% of proliferationinhibitory effects were recognized in a dose of 2.5 or 5.0 μM, respectively. Cell viability was only weakly reduced by VPA (0.5 mM). However, in combination of 5-FU (1.0 μM) with VPA (0.5 mM), 19% of inhibitory effect was observed. Cholangiocarcinoma (HuCCT1) : 5-FU (1.0 μM) did not suppress the cell viability, but 5-FU (2.5 μM) suppressed by 23%. VPA (0.5 mM) did not suppress the cell viability, while VPA (1.0 mM) weakly decreased it by 11%. Combination of 5-FU (1.0 μM) and VPA (0.5 mM) markedly reduced the cell viability by 30%. Conclusion : VPA augmented the anti-tumor effects of 5-FU in cancer cell lines. Therefore, a combination therapy of 5-FU plus VPA may be a promising therapeutic option for patients with pancreas cancer and cholangiocarcinoma

ニクガンテキ モンミャク シンシュウ ヨウセイ カンガン セツジョゴ ノ Systemic IFN＋Low dose FP ノ ユウヨウセイ : リロンテキ コンキョ ト リンショウテキ コウカ

Background and Aims : Despite a recent progress of treatment for hepatocellular carcinoma （HCC）, the prognosis of advanced HCC with macroscopic vascular invasion remains unsatisfactory. We investigated anti-tumor effect of IFNα using experimental model and show the outcome of our systemic adjuvant therapy consisting of IFNα,５FU and cisplatin（IFP）after hepatectomy on advanced HCC with macroscopic portal invasion. Methods［: Basic study］Anti-tumor effects such as inhibition of invasion, proliferation of pegylated IFN α２b（PegIFNα）was evaluated using MH１３４mouse HCC cells, in vitro and vivo. ［Clinical study］: Thirty patients who had HCC with Vp２or more of macroscopic portal invasion（Vp２; portal vein tumor thrombus in its２nd order branch）were included. Those patients were retrospectively divided into two groups : the systemic IFNα,５FU and cisplatin group （n＝１４, IFP group）; and the no adjuvant therapy group（n＝１６, control）. Clinicopathological variables were compared between the two groups, including patient survival and disease-free survival. Results［: Basic］In vitro, the proliferation was significantly suppressed by Peg-IFNα, and invasion potential was also inhibited. In vivo, tumor growth was significantly suppressed compared to control （０．５vs.５．０cm, p＜０．０５）, and liver metastases was decreased（number :１９vs.６, p＜０．０５）. ［Clinical］The overall and disease-free survival rate in IFP group was significantly higher than in control group（１y :１００％ vs３８％,３y :６５％ vs２５％, P＜０．０１,１y :３６％ vs２５％,３y :３６％ vs１９％, P＜０．０１）. Regarding the recurrent patterns,５of９patients in IFP group had controllable tumors in the remnant liver, although１２of１３patients in control group had distant metastasis or multiple recurrences in the residual liver. Conclusion : Our new adjuvant regimen of systemic IFP may be a promising strategy after radical resection for HCC with macroscopic portal invasion

Hilar cholangiocarcinoma accompanied by pancreaticobiliary maljunction without bile duct dilatation 20 years after cholecystectomy : report of a case

Pancreaticobiliary maljunction (PBM) is associated with the occurrence of biliary cancer due to pancreatobiliary reflux. From the perspective of carcinogenesis, the treatment for PBM is controversial. We herein report a case of hilar cholangiocarcinoma 20 years after the occurrence of gallbladder cancer. A 75-year-old man was referred to our hospital regarding an obstructive jaundice and bile duct tumor. A cholecystectomy was performed for cholelithiasis on this patient 20 years ago, and cancer in situ was detected. Computed tomography (CT) and endoscopic retrograde cholangiopancreatography (ERCP) revealed a tumor of the portal hepatic region and PBM without dilatation of the bile duct. Adenocarcinoma was detected from bile cytology, and we diagnosed hilar cholangiocarcinoma. Despite the biliary decompression, jaundice was prolonged and the patient passed away. Our case suggests that not only cholecystectomy but also biliary diversion is needed for PBM regardless of the existence of bile duct dilatation

Hepatic epithelioid angiomyolipoma with arterioportal venous shunting mimicking hepatocellular carcinoma : report of a case

A patient with hepatic epithelioid angiomyolipoma (Epi-AML) with arterioportal venous shunting, who was successfully treated by a laparoscopic left lateral sectionectomy, is presented herein. AML is an uncommon benign neoplasm of the liver. Tumors composed predominantly of epithelioid cells have been subcategorized into Epi-AML, and the treatment strategy for Epi-AML is currently undetermined. There are no reports describing Epi-AML with arterioportal venous shunting to date. An arterioportal venous shunting of the liver tumor was suggested to be one of the malignant signs of the liver tumor. It would be important to differentiate Epi-AML with arterioportal venous shunting from hepatocellular carcinoma and hypervascular metastatic tumors. Minimally invasive resection, such as laparoscopic hepatectomy, for patients having Epi-AML with arterioportal venous shunting may be recommended

A fully programmable 100-spin coherent Ising machine with all-to-all connections

Unconventional, special-purpose machines may aid in accelerating the solution of some of the hardest problems in computing, such as large-scale combinatorial optimizations, by exploiting different operating mechanisms than those of standard digital computers. We present a scalable optical processor with electronic feedback that can be realized at large scale with room-temperature technology. Our prototype machine is able to find exact solutions of, or sample good approximate solutions to, a variety of hard instances of Ising problems with up to 100 spins and 10,000 spin-spin connections