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Objective Pancreatic cancer stem-like cells (P-CSLCs) are thought to be associated with poor prognosis. Previously, we used proteomic analysis to identify a chaperone pro-phagocytic protein calreticulin (CALR) as a P-CSLC-specific protein. This study aimed to investigate the association between CALR and P-CSLC. Methods PANC-1-Lm cells were obtained as P-CSLCs from a human pancreatic cancer cell line, PANC-1, using a sphere induction medium followed by long-term cultivation on laminin. To examine the cancer stem cell properties, subcutaneous injection of the cells into immune-deficient mice and sphere formation assay were performed. Cell surface expression analysis was performed using flow cytometry. Results PANC-1-Lm showed an increased proportion of cell surface CALR-positive and side-population fractions compared with parental cells. PANC-1-Lm cells also had higher frequency of xenograft tumor growth and sphere formation than PANC-1 cells. Moreover, sorted CALRhigh cells from PANC-1-Lm had the highest sphere formation frequency among tested cells. Interestingly, the number of programmed death-ligand 1-positive cells among CALRhigh cells was increased as well, whereas that of human leukocyte antigen class I-positive cells decreased. Conclusion In addition to the cancer stem cell properties, the P-CSLC, which showed elevated CALR expression on the cell surface, might be associated with evasion of immune surveillance.

Few reports exist regarding surgical resection of metachronous lung metastases (MLM) from pancreatic ductal adenocarcinoma (PDA) after curative resection. To elucidate the indications for surgical resection of MLM and long-term survival, we analyzed Japanese case reports of MLM from PDA. Between 1983 and 2014, 17 Japanese case reports concerning surgical resection of MLM from PDA were published. We determined long-term survival in 16 patients (considering the published data of 15 patients and 1 of our own) by using a questionnaire survey and analyzing the relationships between background factors and long-term survival. In 16 patients with long-term survival, 4 patients were still alive without recurrence. The remaining 12 patients died of disease after recurrence. The median survival after the initial lobectomy was 37 months and the 3- and 5-year survival for all patients after lobectomy was 50% and 41%, respectively. Fourteen patients had a disease-free interval after initial resection of the primary pancreatic tumor of20 months. These patients had a longer median survival period after lobectomy (46 vs. 25.5 mo, P=0.19). Seven patients had MLM of16 mm. These patients had a statistically longer overall survival after lobectomy (83 vs. 16 mo, P=0.04). Three of 4 patients with primary stage I tumors were still alive without recurrence. We found that the conventional criteria for surgical resection of MLM from PDA (first disease-free interval of20 mo with no other metastatic lesions) were appropriate. In addition, it is possible that MLM of16 mm or primary stage I tumors are novel criteria.

Introduction We have reported previously that fecal DNA testing of TWIST1 methylation in combination with the fecal immunochemical test for hemoglobin (FIT) (combination test) is useful for colorectal neoplasia screening. In this study, using larger sample sizes, we studied the clinical performance of the combination test for the detection of colorectal neoplasia and, especially, advanced colorectal adenoma. Methods We performed a prospective study in which FIT, fecal DNA testing of TWIST1 methylation, and colonoscopy were performed on 372 patients with colorectal neoplasia and 71 subjects without colorectal neoplasia. We assessed the individual clinical performance of each of FIT and fecal DNA testing of TWIST1 methylation and of the combination test for the detection of colorectal neoplasia including advanced adenoma based on morphologic subtypes. Results The FIT alone had a sensitivity of 7.5% (3/40) for nonadvanced adenoma, 32.3% (41/127) for advanced adenoma, and 93.7% (192/205) for colorectal cancer and a specificity of 87.3% (62/71). The combination test had a sensitivity of 35.0% (14/40) for nonadvanced adenoma, 68.5% (87/127) for advanced adenoma, and 95.6% (196/205) for colorectal cancer and a specificity of 80.3% (57/71). For morphological subtypes of advanced adenoma, the sensitivity of FIT was only 28.2% (20/71) for polypoid type and 16.1% (5/31) for nonpolypoid type, whereas the combination test increased the sensitivities to 64.8% (46/71) and 71.0% (22/31), respectively. Discussion The combination of the fecal DNA test with FIT seemed to be useful to detect colorectal neoplasia and, especially, advanced adenoma of the nonpolypoid type.

Background— The safety of drug-eluting stents in ST-segment elevation myocardial infarction (STEMI) continues to be debated. Pathological studies have demonstrated an association between uncovered struts and subsequent stent thrombosis. Optical coherence tomography can detect stent strut coverage in vivo on a micron-scale level. We therefore used optical coherence tomography to examine strut coverage in patients with STEMI treated with paclitaxel-eluting stents (PES) and bare metal stents (BMS). Methods and Results— In the Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction (HORIZONS-AMI) trial, patients with STEMI were randomized 3:1 to PES or BMS implantation. In a formal substudy, optical coherence tomography at 13 months was performed in 118 consecutive randomized patients (89 PES, 29 BMS) in whom 188 stents were assessed (146 PES and 42 BMS). A total of 44 139 stent struts were analyzed by an independent core laboratory blinded to stent assignment. The primary prespecified end point, the percentage of uncovered stent struts per lesion at follow-up, was 1.1±2.5% in BMS lesions versus 5.7±7.0% in PES lesions ( P P =0.0003). Percentage net volume obstruction was 36.0±15.4% with BMS and 19.2±11.3% with PES ( P Conclusions— In patients with STEMI undergoing primary percutaneous coronary intervention, implantation of PES as compared with BMS significantly reduces neointimal hyperplasia but results in higher rates of uncovered and malapposed stent struts as assessed by optical coherence tomography at 13-month follow-up. Further studies are required to determine the clinical significance of these findings. Clinical Trial Registration— URL: http://www.clinicaltrials.gov . Unique identifier: NCT00433966.

Introduction: Frequency domain optical coherence tomography (FDOCT) can evaluate erythrocyte-rich thrombus, containing more inflammatory cells and reflect high thrombus burden, leading to impaired myocardial reperfusion in myocardial infarction patients. Hypothesis: The purpose of this study was to validate the quantified FDOCT signal analysis in evaluating the erythrocyte-rich thrombus with ex-vivo materials. Methods: We evaluated 55 specimens of coronary artery thrombus obtained by thrombectomy from 9 patients with acute coronary syndrome. The thrombi were immersed in saline immediately after the thrombectomy and FDOCT image acquisition was performed. Quantitative FDOCT analysis for all contiguous frames was performed by the dedicated automated software (OCT system software, Light Lab Inc.). In each sample, signal intensity and normalized standard deviation of signal (NSD) were evaluated quantitatively for a frame showing the biggest thrombus area. All thrombi were stained with hematoxylin-eosin, and the cellular component of erythrocyte were stained using monoclonal antibodies against a protein specific to erythrocyte membranes (glycophorin-A). Computer-assisted analysis was performed using dedicated software (WinROOF, Mitani Corp., Tokyo, Japan) for color identification of the erythrocyte area. Results: Erythrocyte-rich thrombus (n=26), defined as %erythrocyte area (erythrocyte area/total area X100)≧67%, showed higher [NSD / mean signal intensity X100] than white thrombus (n=21), defined as %erythrocyte area Conclusions: This study showed the utility of quantified FDOCT signal analysis on the evaluation of erythrocyte-rich thrombus.

Combined spinal and epidural anesthesia may increase the risk of epidurally administered drugs spreading into the subarachnoid space through the dural hole. We studied the effect of dural puncture with a 26-gauge needle on the spread of analgesia induced by epidural injection of local anesthetics. Forty patients were randomly assigned to control and dural puncture groups. In the dural puncture group, the dura was punctured with a 26-gauge Whitacre spinal needle at L2-3 but no drug was injected. In both groups, an 18-gauge epidural catheter was inserted 4 cm cephalad into the epidural space at L2-3 and 15 mL of 2% mepivacaine without epinephrine was injected. Analgesia was assessed by pinprick at 5, 10, 15, and 20 min after injection and at the end of surgery. The caudal spread of analgesia was significantly greater in the dural puncture group than in the control group 15 and 20 min after injection (P < 0.01), but the cranial spread of analgesia was not different between the two groups. We conclude that dural puncture (without drugs) using a 26-gauge Whitacre spinal needle before epidural injection increases caudal spread of analgesia induced by epidural local anesthetics.

Intravenous liquid halothane causes severe pulmonary edema when administered for suicide attempts. This study was carried out to elucidate the cardiopulmonary effects of intravenous liquid halothane in 14 dogs. Subjects were divided into three groups: group 1 (n = 4) was the control; group 2 (n = 5) received 7.5 mmol intravenous liquid halothane; and group 3 (n = 5) received pretreatment of continuous infusion of prostaglandin E1 at a rate of 0.02 microgram.kg-1.min-1, followed by 7.5 mmol intravenous liquid halothane. Hemodynamic values, extravascular lung water, and arterial blood gas tensions were measured for 240 min. In group 2, thromboxane B2, beta-glucuronidase, and lipid peroxides were measured in four of five dogs. In group 2, intravenous liquid halothane caused pulmonary edema associated with hypoxemia, pulmonary hypertension, and left ventricular dysfunction. In group 3, prostaglandin E1, given to reduce pulmonary vasoconstriction and left ventricular preload, aggravated hypoxemia and pulmonary hypertension and impaired left ventricular contractility, although end-diastolic left ventricular pressure was low. Thromboxane B2 increased, whereas beta-glucuronidase and lipid peroxides did not change after administration of intravenous halothane. We conclude that pulmonary edema induced by intravenous liquid halothane was due to direct pulmonary vascular damage, and that pulmonary vasoconstriction and increased left ventricular preload were not contributory causes.