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It has been postulated that the combination of intracavitary and interstitial brachytherapy (IC/IS) is effective and safe for large and irregularly shaped uterine cervical cancer patients. However, due to its invasiveness compared to conventional intracavitary brachytherapy (ICBT), it has to be said that the implementation speed of IC/IS is slow. Until now, there have been no guidelines for required equipment, human resources, and procedural guide focusing solely on IC/IS. The purpose of this guideline is to provide radiation oncologists and medical physicists who wish to start IC/IS with practical and comprehensive guidance for a safe IC/IS introduction and to help accelerate the spread of the utilization of IC/IS nationwide. This is the English translation of the Japanese IC/IS Guidelines, and it was created in an effort to share the Japanese approach to the management of locally advanced uterine cervical cancer worldwide.

BackgroundThe prognosis of intrahepatic cholangiocarcinoma (ICC) has been poor, because of the high recurrence rate even after curative surgery. This study aimed to evaluate the prognostic impact of surgical resection of recurrent ICC.Patients and methodsA total of 345 cases of ICC who underwent hepatectomy with curative intent in 17 institutions were retrospectively analyzed, focusing on recurrence patterns and treatment modalities for recurrent ICC.ResultsMedian survival time and overall 5-year recurrence-free survival rate were 17.8 months and 28.5%, respectively. Recurrences (n = 223) were classified as early (recurrence at ≤1 year, n = 131) or late (recurrence at >1 year, n = 92). Median survival time was poorer for early recurrence (16.3 months) than for late recurrence (47.7 months, pConclusionSurgical resection of recurrent ICC could improve survival after recurrence, especially for patients with intra- or extrahepatic recurrence as resectable oligo-metastases.

The presence of circulating tumor cells (CTCs) in the peripheral blood is associated with short survival, making the detection of CTCs clinically useful as a prognostic factor of disease outcome and/or a surrogate marker of treatment response. Recent technical advances in immunocytometric analysis and quantitative real-time PCR have made it possible to detect a few CTCs in the blood; however, there is no sensitive assay to specifically detect viable CTCs. Here, we report what we believe to be a new approach to visually detect live human CTCs among millions of peripheral blood leukocytes, using a telomerase-specific replication-selective adenovirus expressing GFP. First, we constructed a GFP-expressing attenuated adenovirus, in which the telomerase promoter regulates viral replication (OBP-401; TelomeScan). We then used OBP-401 to establish a simple ex vivo method that was able to detect viable human CTCs in the peripheral blood. The detection method involved a 3-step procedure, including the lysis of rbc, the subsequent addition of OBP-401 to the cell pellets, and an automated scan using fluorescence microscopy. OBP-401 infection increased the signal-to-background ratio as a tumor-specific probe, because the fluorescent signal was amplified only in viable, infected human tumor cells, by viral replication. This GFP-expressing virus-based method is remarkably simple and allows precise enumeration of CTCs.

The bandwidth B ( G ) of a graph G is the minimum of the quantity max{| f ( x )− f ( y )|: xy ∈ E ( G )} taken over all injective integer numberings f of G . The cartesian product of two graphs G and H , written as G × H , is the graph with vertex set V ( G )× V ( H ) and with ( u 1 , v 1 ) adjacent to ( u 2 , v 2 ) if either u 1 is adjacent to u 2 in G and v 1 = v 2 or u 1 = u 2 and v 1 is adjacent to v 2 in H . In this paper we investigate the bandwidth of the cartesian product of two connected graphs. For a graph G , we denote the diameter of G and the connectivity of G by D ( G ) and κ ( G ), respectively. Let G and H be two connected graphs. Among other results, we show that if B ( H )= κ ( H ) and | V ( H )|⩾2 B ( H ) D ( G )−min{1, D ( G )−1}, then B ( G × H )= B ( H )| V ( G )|. Moreover, the order condition in this result is sharp.

Highlights • Secondary aortoduodenal fistula is one of life-threatening complication after surgical treatment for abdominal arterial aneurysm. • The most important factor for acute management is controlling the bleeding from the fistula. • Intra-aortic balloon occlusion may be one option for management of secondary aortoduodenal fistula., Introduction Secondary aortoduodenal fistula (SADF) is a rare but life-threatening complication after aortic reconstruction. Although a number of reports describing treatments for SADF have been published, the optimal management is unclear. A review of the literature suggested methods of reconstruction, control of bleeding, and reduction of infection in the management of SADF. The most important factor for acute intervention is controlling the bleeding from the fistula. We report one case treated using intra-aortic balloon occlusion (IABO) for SADF. Presentation of a case We describe a case of secondary aortoduodenal fistula that occurred seven years following aortobifemoral reconstruction for abdominal aortic aneurysm. Discussion Early control of bleeding is essential for survival of the patient. Emergency laparotomy or endovascular stenting frequently have been chosen as interventions, although each approach has significant limitations. Emergency laparotomy for patients with hemodynamic instability may create excessive physiologic stress, and endovascular stenting may not be available at every surgical facility. The use of IABO for cases of intraperitoneal bleeding due to trauma has been previously described. IABO is relatively easy to implement, and enabled us to control the bleeding from the aorta more rapidly than other strategies. Conclusion Based on a review of the literature and our own experience, IABO should be considered as one option for the management of SADF.

The bandwidth B ( G ) of a graph G is the minimum of the quantity max {|f(x)−f(y)| : xy∈E(G)} taken over all proper numberings f of G . The composition of two graphs G and H , written as G [ H ], is the graph with vertex set V ( G )× V ( H ) and with ( u 1 , v 1 ) is adjacent to ( u 2 , v 2 ) if either u 1 is adjacent to u 2 in G or u 1 = u 2 and v 1 is adjacent to v 2 in H . In this paper, we investigate the bandwidth of the composition of two graphs. Let G be a connected graph. We denote the diameter of G by D ( G ). For two distinct vertices x , y ∈ V ( G ), we define w G ( x , y ) as the maximum number of internally vertex-disjoint ( x , y )-paths whose lengths are the distance between x and y . We define w ( G ) as the minimum of w G ( x , y ) over all pairs of vertices x , y of G with the distance between x and y is equal to D ( G ). Let G be a non-complete connected graph and let H be any graph. Among other results, we prove that if | V ( G )|= B ( G ) D ( G )− w ( G )+2, then B ( G [ H ])=( B ( G )+1)| V ( H )|−1. Moreover, we show that this result determines the bandwidth of the composition of some classes of graphs composed with any graph.

Introduction Solid pseudopapillary neoplasm of the pancreas is a rare neoplasm that has been reported to account for between 0.17% and 2.7% of all non-endocrine tumors of the pancreas. It is usually seen in young women. Because solid pseudopapillary neoplasms are rarely aggressive and have low-grade malignant potential and an excellent prognosis after complete resection, it is an ideal pancreatic tumor for treatment by minimally invasive surgery. Therefore, making an accurate pre-operative diagnosis is very important. Case presentation A 24-year-old Japanese man who had been found to have mild transaminase elevations at a medical check-up visited our hospital for further examination. Abdominal computed tomography showed a 40mm-diameter tumor in the pancreatic tail and mild fatty liver. He was admitted to our hospital for additional examination. The abdominal contrast-enhanced computed tomography scan taken at our institution showed an increasingly enhanced mass of 40mm diameter in the pancreatic tail. Ultrasonography showed a low-level echoic mass of 35mm diameter in the pancreatic tail. T1-weighted magnetic resonance imaging showed low signal intensity in the tail of the pancreas. T2-weighted magnetic resonance imaging showed high signal intensity there. Diffusion magnetic resonance imaging showed high signal intensity. An endoscopic ultrasound yielded the same results as the abdominal ultrasonogram. In addition, [18F]-fluorodeoxyglucose positron emission tomography/computed tomography showed abnormal accumulation (maximum standardized uptake value, 6.53). This finding raised our suspicion of a pancreatic malignant tumor. However, the patient could not be confidently diagnosed solely on the basis of imaging. Endoscopic ultrasound-guided fine-needle aspiration was performed, which led us to a diagnosis of solid pseudopapillary neoplasm. On that basis, we performed minimally invasive surgery (spleen-preserving laparoscopic distal pancreatectomy). Conclusion Atypical solid pseudopapillary neoplasm without cysts should be considered when diagnosing pancreatic tumors. A definitive pre-operative diagnosis of solid pseudopapillary neoplasm made on the basis of endoscopic ultrasound-guided fine-needle aspiration can guide the surgical approach used.