PICA communicating artery aneurysm

This report presents a rare case of such an aneurysm arising from such a communicating artery. A 66-year-old woman presented with a subarachnoid hemorrhage located predominantly in the cisterna magna with intraventricular hemorrhage. Angiography showed hypoplasia of the right posterior inferior cerebellar artery. Its vermian territory was supplied by the communicating artery from the posterior medullary segments of the left posterior inferior cerebellar artery. An aneurysm was on that communicating artery itself at a nonbranching site. The aneurysm was trapped the next day. Postoperative computed tomography showed no infarct in the right posterior inferior cerebellar artery territory. Trapping is applicable when other collateral vessels supply the contralateral posterior inferior cerebellar artery territory

Transarterial embolization for convexity dural arteriovenous fistula

Background: Convexity dural arteriovenous fistulae (dAVF) usually reflux into cortical veins without involving the venous sinuses. Although direct drainage ligation is curative, transarterial embolization (TAE) may be an alternative treatment. Case Description: Between September 2018 and January 2021, we encountered four patients with convexity dAVFs. They were three males and one female; their age ranged from 36 to 73 years. The initial symptom was headache (n = 1) or seizure (n = 2); one patient was asymptomatic. In all patients, the feeders were external carotid arteries with drainage into the cortical veins; in two patients, there was pial arterial supply from the middle cerebral artery. All patients were successfully treated by TAE alone using either Onyx or N-butyl cyanoacrylate embolization. Two patients required two sessions. All dAVFs were completely occluded and follow-up MRI or angiograms confirmed no recurrence. Conclusion: Our small series suggests that TAE with a liquid embolic material is an appropriate first-line treatment in patients with convexity dAVFs with or without pial arterial supply

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

Clinical role of Foxp3+regulatory T cell in Living donor related liver transplantation for prediction of life-threatening complications

Purposes : It is no doubt that regulatory T cells (Foxp3+CD4+CD25+T cells : Treg) play important roles in transplant immunity.We investigated the significance of Treg expression in acute stage of living donorrelated liver transplantation (LDLT) for the possibility of the sensitive marker for immunological state and homeostatic stress after liver transplantation. Methods : Peripheral blood was drawn from 5 recipients of LDLT preoperatively and on post operative 1, 4, 7, and 14 days. The peripheral blood mononuclear cells (PBMCs) were stained with CD4, CD25, Foxp3, and were analyzed with FACScan. This data was compared with clinical output of LDLT. Result : The populations of Treg were significantly decreased in all patients on day 1 after LDLT and significantly increased in patients who had early postoperative complications compared with patients who had no complications. Conclusions : The population of Treg in peripheral blood may reflect the surgical stress such as life-threatening complications after LDLT

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

ショウカキガン ニオケル HIF-1 ノ リンショウテキ イギ ト チリョウ エノ オウヨウ

Hypoxia inducible factor‐１α（HIF‐１α）and histone deacetylase（HDAC）expressions in gastrointestinal cancer, especially intrahepatic cholangiocarcinoma and pancreas cancer, significantly reflect on the malignant potential of these cancers, and are significantly associated with patient’s prognosis. It has also been shown that HIF‐１α is deacetylated and stabilized by nucleosome remodeling and histone deacetylation （NuRD）　complex, consisting of HDAC and metastasis-associated gene‐１（MTA１）, leading to angiogenesis. More recently, it has been reported that HIF‐１α induces tumorigenesis and ultimately cancer stemness through epithelial-mesenchymal transition （EMT）. Therefore, HIF‐１α may be one of the master molecules of cancer progression, and it is expected that novel therapeutic strategies will be devised by controlling the signaling pathway of HIF‐１α in hypoxic condition of gastrointestinal cancer

ショウカキガン ニオケル HIF-1 ノ リンショウテキ イギ ト チリョウ エノ オウヨウ

Hypoxia inducible factor‐１α（HIF‐１α）and histone deacetylase（HDAC）expressions in gastrointestinal cancer, especially intrahepatic cholangiocarcinoma and pancreas cancer, significantly reflect on the malignant potential of these cancers, and are significantly associated with patient’s prognosis. It has also been shown that HIF‐１α is deacetylated and stabilized by nucleosome remodeling and histone deacetylation （NuRD）　complex, consisting of HDAC and metastasis-associated gene‐１（MTA１）, leading to angiogenesis. More recently, it has been reported that HIF‐１α induces tumorigenesis and ultimately cancer stemness through epithelial-mesenchymal transition （EMT）. Therefore, HIF‐１α may be one of the master molecules of cancer progression, and it is expected that novel therapeutic strategies will be devised by controlling the signaling pathway of HIF‐１α in hypoxic condition of gastrointestinal cancer

CD44 expression in HCC

Background: CD44 is well known to be one of the cancer stem cell markers and is a cell-surface glycoproteininvolved in cell-cell interactions, cell adhesion, and cell migration. We investigated the role of CD44 expression in both tumor and non-tumor tissues on recurrence of hepatocellular carcinoma (HCC). Methods: Forty-eight patients with HCC who underwent hepatic resection at our institution were enrolled in this study. CD44 expressions in both tumor and non-tumor tissues were examined using real time reverse transcription-polymerase chain reaction. The patients were divided into two groups: high and low gene-expression group, based on the CD44 expression level. We compared the clinicopathological factors between the high expression and low expression groups in both tumor and non-tumor tissues. Results: In the tumor tissues, the gene-expression levels of CD44 did not correlate with any clinicopathological parameters. The disease-free survival rate showed no significant difference between the two gourps. In non-tumor tissues, although there was no significant relationship between the CD44 expression levels and clinicopathological factors, disease-free survival rate in the CD44 low expression group was significantly better than that in the CD44 high expression group (p<0.05). In multivariate analysis, the risk factors in tumor recurrence were presence of microscopic portal invasion and high expression level of CD44. Conclusion: The CD44 expressions in the non-tumor tissues may predict HCC recurrence

Integrative Annotation of 21,037 Human Genes Validated by Full-Length cDNA Clones

The human genome sequence defines our inherent biological potential; the realization of the biology encoded therein requires knowledge of the function of each gene. Currently, our knowledge in this area is still limited. Several lines of investigation have been used to elucidate the structure and function of the genes in the human genome. Even so, gene prediction remains a difficult task, as the varieties of transcripts of a gene may vary to a great extent. We thus performed an exhaustive integrative characterization of 41,118 full-length cDNAs that capture the gene transcripts as complete functional cassettes, providing an unequivocal report of structural and functional diversity at the gene level. Our international collaboration has validated 21,037 human gene candidates by analysis of high-quality full-length cDNA clones through curation using unified criteria. This led to the identification of 5,155 new gene candidates. It also manifested the most reliable way to control the quality of the cDNA clones. We have developed a human gene database, called the H-Invitational Database (H-InvDB; http://www.h-invitational.jp/). It provides the following: integrative annotation of human genes, description of gene structures, details of novel alternative splicing isoforms, non-protein-coding RNAs, functional domains, subcellular localizations, metabolic pathways, predictions of protein three-dimensional structure, mapping of known single nucleotide polymorphisms (SNPs), identification of polymorphic microsatellite repeats within human genes, and comparative results with mouse full-length cDNAs. The H-InvDB analysis has shown that up to 4% of the human genome sequence (National Center for Biotechnology Information build 34 assembly) may contain misassembled or missing regions. We found that 6.5% of the human gene candidates (1,377 loci) did not have a good protein-coding open reading frame, of which 296 loci are strong candidates for non-protein-coding RNA genes. In addition, among 72,027 uniquely mapped SNPs and insertions/deletions localized within human genes, 13,215 nonsynonymous SNPs, 315 nonsense SNPs, and 452 indels occurred in coding regions. Together with 25 polymorphic microsatellite repeats present in coding regions, they may alter protein structure, causing phenotypic effects or resulting in disease. The H-InvDB platform represents a substantial contribution to resources needed for the exploration of human biology and pathology