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Background The vein that runs between ventral and dorsal Segment 8 is called the anterior fissure vein (AFV). AFV is sometimes needed as a boundary for Subsegmentectomy in Segment 8. The aim of the present study was to investigate the AFV to determine whether the AFV can be used a landmark for subsegmentectomy of the liver at Segment 8. Methods We analyzed data from 151 patients who had undergone abdominal computed tomographic (CT) examinations. The position of the AFV is identified by determining whether the AFV drains flows into the proximal, medial, or distal portion of the middle hepatic vein (MHV) or right hepatic vein (RHV). Furthermore, the proximal region is divided into 2 halves; the proximal portion is designated as P1 and the distal portion is designated as P2. Results The AFV could be identified in 78.8% (119/151) of the patients. The AFV flowed into the MHV in 84.9% of the patients and into the RHV in 15.1%. Among the former, the AFV flowed into the proximal MHV in 69.7% of the patients. Conclusions Although the AFV might not be easily identifiable, the AVF can be used to determine the border between the ventral and dorsal portions of Segment 8. The AFV should thus be used as a landmark for Subsegmentectomy.

A 72-year-old man underwent total gastrectomy for gastric cancer (por2, T3, N2, Stage IIIA). Eleven courses of postoperative chemotherapy with TS-1 (tegafur/gimeracil/oteracil) were administered. Five months after surgery, the serum carcinoembryonic antigen value was slightly elevated. However, computed tomography did not reveal any metastatic lesions in other organs. Two years after surgery, the patient felt a mass in the left mammary. A 2-cm tumor was palpable in the central portion of the breast. Ultrasonography revealed a hypoechoic tumor, which was Class 3 on aspiration biopsy cytological examination. No mass was detected on positron emission tomography-computed tomography. The mammary gland tumor increased in size to 3 cm, and a core needle biopsy procedure was performed. Histological examination findings revealed breast metastasis of gastric cancer. No other recurrence was found, and radical mastectomy was performed 2 years and 5 months after gastrectomy. Immunohistological analysis of the resected material confirmed breast metastasis of the gastric cancer. Two courses of TS-1 + cisplatin were administered, but this treatment was subsequently terminated because the patient experienced Grade 3 diarrhea and neutropenia. Three years and 1 month after the gastrectomy, the tumor recurred in the pelvic area. Chemotherapy and radiation therapy were performed, but the patient's overall condition became progressively worse, and he died 3 years and 9 months after gastrectomy.

Objective The purpose of this study is to evaluate whether laterality of the superficial cerebral veins can be seen on susceptibility-weighted imaging (SWI) in patients with no intracranial lesions that affect venous visualization. Methods We retrospectively evaluated 386 patients who underwent brain magnetic resonance imaging including SWI in our institute. Patients with a lesion with the potential to affect venous visualization on SWI were excluded. Two neuroradiologists visually evaluated the findings and scored the visualization of the superficial cerebral veins. Results Of the 386 patients, 315 (81.6%) showed no obvious laterality on venous visualization, 64 (16.6%) showed left-side dominant laterality, and 7 (1.8%) showed right-side dominant laterality. Conclusions Left-side dominant physiological laterality exists in the visualization of the superficial cerebral veins on SWI. Therefore, when recognizing left-side dominant laterality of the superficial cerebral veins on SWI, the radiologist must also consider the possibility of physiological laterality.

Photosynthesis converts light energy into biologically useful chemical energy vital to life on Earth. The initial reaction of photosynthesis takes place in photosystem II (PSII), a 700-kilodalton homodimeric membrane protein complex which catalyses photo-oxidation of water into dioxygen through an S-state cycle of the oxygen evolving complex (OEC). The structure of PSII has been solved by X-ray diffraction (XRD) at 1.9-ångström (Å) resolution, which revealed that the OEC is a Mn4CaO5-cluster coordinated by a well-defined protein environment1. However, extended X-ray absorption fine structure (EXAFS) studies showed that the manganese cations in the OEC are easily reduced by X-ray irradiation2, and slight differences were found in the Mn–Mn distances between the results of XRD1, EXAFS3–7 and theoretical studies8–14. Here we report a ‘radiation-damage-free’ structure of PSII from Thermosynechococcus vulcanus in the S1 state at a resolution of 1.95 Å using femtosecond X-ray pulses of the SPring-8 ångström compact free-electron laser (SACLA) and a huge number of large, highly isomorphous PSII crystals. Compared with the structure from XRD, the OEC in the X-ray free electron laser structure has Mn–Mn distances that are shorter by 0.1–0.2 Å. The valences of each manganese atom were tentatively assigned as Mn1D(III), Mn2C(IV), Mn3B(IV) and Mn4A(III), based on the average Mn–ligand distances and analysis of the Jahn–Teller axis on Mn(III). One of the oxo-bridged oxygens, O5, has significantly longer Mn–O distances in contrast to the other oxo-oxygen atoms, suggesting that it is a hydroxide ion instead of a normal oxygen dianion and therefore may serve as one of the substrate oxygen atoms. These findings provide a structural basis for the mechanism of oxygen evolution, and we expect that this structure will provide a blueprint for design of artificial catalysts for water oxidation.

Introduction Laparoscopic distal pancreatectomy (Lap-DP) has been recognized worldwide as a feasible and highly beneficial procedure. The aim of this study is to investigate whether Lap-DP techniques are being implemented safely by surgeons training to perform this procedure. Methods We retrospectively compared the perioperative outcomes of Lap-DP in patients operated on by the surgeon originating this procedure at our hospital (expert surgeon group [E group], n = 47) and patients operated on by surgeons training to perform this procedure (training surgeons group [T group], n = 53). Results The median operating times for the E group and T group were 321 min (range, 150–653 min) and 314 min (range, 173–629 min), respectively; these times were not significantly different (P = 0.4769). The median blood loss in the T group (100 mL; range, 0–1950 mL) was significantly smaller than in the E group (280 mL; range, 0–1920 mL) (P = 0.0003). There were no significant intergroup differences in other operative results: combined operation ratio, spleen- and splenic vessels-preserving ratio, hand-assisted procedure ratio, and the ratio of transition to open. The frequency of pancreatic fistulas in the E group and T group was 12.8% and 16.9%, respectively; these rates were not significantly different (P = 0.5886). There were no significant differences between the two groups in terms of other complications and reoperation rates. The median hospital stay for the E group was significantly shorter than for the T group (10 vs 13 days; P = 0.0307). Conclusion This retrospective analysis shows that teaching safe Lap-DP techniques to surgeons is reflected in stable perioperative outcomes.

An online UV–visible microspectrophotometer has been developed for the macromolecular crystallography beamline at SPring-8. Details of this spectrophotometer are reported., Measurement of the UV–visible absorption spectrum is a convenient technique for detecting chemical changes of proteins, and it is therefore useful to combine spectroscopy and diffraction studies. An online microspectrophotometer for the UV–visible region was developed and installed on the macromolecular crystallography beamline, BL38B1, at SPring-8. This spectrophotometer is equipped with a difference dispersive double monochromator, a mercury–xenon lamp as the light source, and a photomultiplier as the detector. The optical path is mostly constructed using mirrors, in order to obtain high brightness in the UV region, and the confocal optics are assembled using a cross-slit diaphragm like an iris to eliminate stray light. This system can measure optical densities up to a maximum of 4.0. To study the effect of radiation damage, preliminary measurements of glucose isomerase and thaumatin crystals were conducted in the UV region. Spectral changes dependent on X-ray dose were observed at around 280 nm, suggesting that structural changes involving Trp or Tyr residues occurred in the protein crystal. In the case of the thaumatin crystal, a broad peak around 400 nm was also generated after X-ray irradiation, suggesting the cleavage of a disulfide bond. Dose-dependent spectral changes were also observed in cryo-solutions alone, and these changes differed with the composition of the cryo-solution. These responses in the UV region are informative regarding the state of the sample; consequently, this device might be useful for X-ray crystallography.

This paper reports an electroplating method with supercritical carbon dioxide (sc-CO 2 ) emulsion (EP-SCE) on hole test element group (TEG), which has an integrated structure of Cu seed layer on TiN barrier layer sputtered on Si substrates. The reaction is carried out in an emulsion of sc-CO 2 in copper-sulfate-based electrolyte with surfactants. It was reported that Ni film obtained by EP-SCE is uniform and without pinhole, because sc-CO 2 has low viscosity and compatibility of hydrogen. Thus, this method is applicable in fine Cu wiring, but dissolution of Cu seed layer in EP-SCE was observed. Therefore, Cu particle was added to form a suspension. An electroplating method with sc-CO 2 suspension (EP-SCS) is proposed to inhibit dissolution of Cu seed layer. Electroplated Cu film obtained by this method was a smooth film without pinhole. Moreover, we applied EP-SCS technique into filling of hole TEG with holes having 60 and 70 nm in diameter, and complete filling of all the holes with electrodeposited Cu without any void was obtained. The Cu filled into the holes was found to be single crystal or had only a few twin boundaries parallel to the surface of TEG. We suggest that crystal growth in EP-SCS could be bottom-up growth along [111] crystallographic orientation of Cu.

Molecularly-thin nanosheets are ultimate two-dimensional (2D) nanomaterials potentially giving unusual physical and chemical properties due to the strong 2D quantum and surface effects. Here, it is demonstrated that 1.5-nm-thick ZnO nanosheets exhibit greatly enhanced room-temperature ferromagnetism. Saturation magnetization value of the nanosheets with intercalated dodecyl sulfate layers is approximately 100 times that of ZnO mesocrystals. Anion exchange with dodecyl phosphate layers strongly suppresses ferromagnetic ordering as a result of surface defect passivation while maintaining bulk-like n-type semiconducting properties, which reveals significance of interfacial states to engineer functional properties of nanosheet-based hybrid materials.

Laparoscopic hepatectomy has become a widespread procedure in Japan, now that the national medical insurance system covers partial resection and lateral segmentectomy. An important procedure during laparoscopic hepatectomy is the division of the vascular pedicles. In this paper we report a practical and useful method for vascular division with an Endo Mini-Retract(TM) retractor and a shortened Nelaton catheter (2.5-mm-diameter) developed in our department.

Bleeding from gastric varices (GVs) is generally considered more severe than that from esophageal varices (EVs) but occurs less frequently. We review the risk factors for bleeding EVs and GVs. GVs were divided into 2 groups: cardiac varices (CVs, Lg-c) and fundal varices (FVs), i.e., varices involving the fundus alone (Lg-f) or varices involving both the cardia and fundus (Lg-cf). Elevated pressure in the portal vein is a risk factor for bleeding EVs. The portal pressure in patients with GVs and a gastrorenal shunt is lower than that in patients with EVs. The large size of varices is a risk factor for bleeding EVs. Red color signs are elevated red areas that are important for predicting the risk of variceal bleeding, and red wale markings, dilated venules oriented longitudinally on the mucosal surface, have been considered to be the sign with the highest risk. Red color signs are rare in FVs, possibly because of the pronounced thickness of the mucosal layer. Bleeding EVs are not associated with use of antiulcer drugs or nonsteroidal anti-inflammatory drugs (NSAIDs). Although, in patients with bleeding GVs, "occasional" use of an oral NSAID is an important step leading to variceal hemorrhage, especially from FVs, even if the mucosa is protected by antiulcer drugs. Constipation, vomiting, severe coughing, and excessive consumption of alcohol may precipitate rupture of EVs.

Introduction. Leiomyosarcomas of vascular origin are particularly rare tumors occurring mainly in the inferior vena cava (IVC). They are malignant, slow-growing tumors with a poor prognosis. This paper reports on a rare case of surgical resection of an IVC leiomyosarcoma mimicking a hepatic tumor.Case Presentation. A 65-year-old Japanese male was admitted for evaluation of an abdominal tumor. Enhanced computed tomography of the abdomen revealed a slightly enhanced heterogeneous tumor, 18 mm in diameter, between the Spiegel lobe of the liver and the IVC in early-phase images, with no enhancement or washout in late-phase images. We diagnosed this tumor as either a hepatic tumor in the Spiegel lobe or a retroperitoneal tumor such as leiomyosarcoma or liposarcoma and performed a laparotomy. On the basis of surgical findings, we extirpated the tumor by performing a wedge resection of the wall of the IVC and suturing the primary IVC wall. Pathological findings led to a further diagnosis of the tumor as a leiomyosarcoma originating in the IVC. Thirty-seven months after the operation, multiple liver and lung metastases were detected, and the patient died from multiple organic failures.Conclusion. We experienced a rare case of a leiomyosarcoma of IVC mimicking hepatic tumor.

Cystic echinococcosis (CE) is a rare afferent infectious disease in Japan. This paper reports a case of a hepatic cyst being diagnosed after surgical resection. A 40-year-old Syrian male was admitted for evaluation of a hepatic cyst. Serum antibodies of echinococcosis were negative. Enhanced computed tomography of the abdomen revealed a large cystic lesion, 9 cm in diameter, in the left lateral sector of the liver, which had many honeycomb-like septa and calcified lesions. Magnetic resonance imaging of this lesion revealed high intensity in the T2 weighted image. We preoperatively diagnosed this lesion as cystadenocarcinoma or CE and performed a left hepatectomy. Pathological examination revealed the presence of protoscolices in the fluid of the cysts and led to a diagnosis of this lesion as CE. In conclusion, on seeing patients with huge hepatic cysts who come from an epidemic area, we should consider hepatic CE.

Laparoscopic liver resection (LLR) became common in Japan when advanced techniques and instruments for the procedure became available and the national medical insurance began covering partial resection and lateral segmentectomy. A successful LLR requires a gentle and powerful hold on the specimens, a steady operating field, and fast and rapid compression of the bleeding point to achieve hemostasis. In this paper we describe two instruments developed in our department by attaching the SECUREA™ endoscopic surgical spacer to the forceps and suction tube used for LLR. The instruments are useful and practical for any type of LLR, even in the hands of less experienced surgeons.

Limy bile syndrome extending to the common bile duct (CBD) is a rare condition that lacks a standardized treatment. Laparoscopic cholecystectomy with laparoscopic choledocholithotomy by CBD exploration is preferred because it preserves the function of the sphincter of the Vater's papilla and allows treatment of both lesions. A 37-year-old man who was receiving entecavir for chronic hepatitis B developed right upper quadrant pain. Abdominal ultrasonography revealed a calcified shadow in the gallbladder and CBD. Abdominal imaging revealed a liquid-like material identified by a calcified shadow in two phases separated by a fluid-fluid level. Abdominal and 3-D drip infusion cholangiography CT showed stones in the gallbladder and CBD with limy bile. The patient underwent laparoscopic cholecystectomy and choledocholithotomy. Intraoperatively, white-yellow-colored bile and stones were drained from the CBD. A C-tube was placed. Postoperatively, remnant stones and radiopaque materials were absent. The stones comprised of95% calcium carbonate.

The association between hypocholesterolemia and lung cancer risk has been confirmed in some studies. The purpose of the study was to determine whether preoperative hypocholesterolemia (below normal range) is a prognostic factor for survival after nonsmall cell lung cancer (NSCLC) resection. Two hundred and sixty-two consecutive cases of resected NSCLC with a followup period for more than 5 years were reviewed retrospectively. In our results, there were only 13/262 patients having hypocholesterolemia. A significant association was observed between preoperative hypocholesterolemia and patients' survival. However, we failed to find the prognostic significance of preoperative hypocholesterolemia by univariate analysis. No statistical differences were also found by the comparison between 5-year survivors and the others. Our data indicates a trend toward an association between preoperative hypocholesterolemia and poorer survival in NSCLC; however, it did not reach statistical significance.

Introduction We introduce a technique for pancreaticojejunostomy with closure of the pancreatic stump by endoscopic linear stapler as a reliable intervention with benefits for pancreatic resection in laparoscopic pancreaticoduodenectomy (Lap-PD). Materials and Surgical Technique Following laparoscopic resection, we perform pancreaticojejunostomy under direct visualization. We employ the same method as in open surgery and enter via a 4–5-cm incision, the minimum size feasible for easy removal of resected material from the body, positioned directly above the stump of the distal pancreas. In January 2011, we began using endoscopic linear stapler when cutting the pancreas during Lap-PD in order to reduce the leakage of pancreatic juice, which may contain tumor cells from the neoplastic lesion. Since then, we have used this procedure in 12 subjects undergoing Lap-PD and 5 subjects undergoing laparoscopic central pancreatectomy. We have observed postoperative complication in only one of the laparoscopic central pancreatectomy cases, involving grade B/C pancreatic fistula, and in none of the Lap-PD cases. Discussion Our pancreaticojejunostomy with closure of the pancreatic stump by endoscopic linear stapler is a feasible procedure in Lap-PD and has produced positive results over a short time frame.

We reported filling of nanoscale holes with high aspect ratio by Cu electroplating with a supercritical carbon dioxide suspension (EP-SCS). The Cu film electrodeposited by the EP-SCS was smooth. The nanoscale holes with 70nm in diameter and aspect ratio of 2 and 5 can be filled by electrodeposited Cu with no voids and pinholes by the EP-SCS. Gap-filling capability of the EP-SCS is high for the nanoscale holes with high aspect ratio even when using Cu electrolyte originally designed to fill holes with 70nm diameter and aspect ratio 1 by conventional method.

Two novel cobalt(II) complexes [Co(L1)2](BF4)2·CH3CN·0.5H2O (1) and [Co(L2)2](BF4)2 (2) (L1 = 4′-(3,4,5-trimethoxy-phenyl)-[2,2′:6′,2″]terpyridine, L2 = 4′-(3,4,5-tris-hexadecyloxy-phenyl)-[2,2′:6′,2″]terpyridine) have been synthesized, and their structural, magnetic and mesomorphic properties were characterized by single crystal X-ray diffraction (XRD) analysis, temperature-dependent magnetic susceptibility, POM, DSC, and powder XRD analysis. The molecular structure of the complex 1 with short alkyl substituents exhibited that the metal ion has an N6 coordination sphere of distorted octahedral geometry and various intermolecular π–π interactions are important factors influencing the crystalline array. The magnetic behaviour of 1 displayed a typical of gradual spin transition for cobalt(II) terpyridine complexes. On the other hand, the complex 2 possessing linear long alkyl chains showed a gradual spin transition between low-spin and high-spin with a thermal hysteresis loop (T 1/2↑ = 338 and T 1/2↓ = 327 K) triggered by the crystal-to-mesophase transition. The powder XRD and POM analyses were indicative of the liquid crystalline lamellar phase of 2.

We herein present a rare case of enterovesical fistula caused by ileal non-Hodgkin's lymphoma. A 75-year-old Japanese male presented with macrohematuria at Kosei General Hospital in December 2010. An egg-sized mass was palpable in his right lower abdominal region, and computed tomography (CT) revealed that the ileal tumor had invaded the right posterior wall of the urinary bladder (UB). A histopathological examination of a CT-guided needle biopsy specimen revealed diffuse large B-cell lymphoma involving the ileum and the UB. Thereafter, fecaluria appeared. A transurethral catheter was put in place, and there were no symptoms of cystitis. The patient received chemotherapy for the lymphoma, which produced a partial response. However, the fecaluria continued, and an examination of the small intestine with contrast revealed a thick and irregular wall of the ileum and a fistula between the ileum and UB. A partial resection of the ileum and a partial cystectomy were carried out in April 2011. The surgical specimen demonstrated two tumors 5 cm apart in the ileum, measuring 4.5 × 7 and 4 × 3 cm in size. The proximal tumor had directly invaded the UB and formed an ileovesical fistula. The patient made a good recovery and was doing well 5 months after the surgery without any evidence of recurrence.

Aims: The relationship between the maximum standardized uptake values (SUVmax) on positron emission tomography (PET) and serum carcinoembryonic antigen (CEA) level in non-small cell lung cancer (NSCLC) patients was investigated. Methods: Consecutively, 197 surgically resected NSCLC patients with preoperative staging including serum CEA and PET were reviewed retrospectively. Results: When patients were subdivided into two groups based on the median value of the SUVmax (6.6), the 5-year survival of patients with a high SUVmax was 63.20%, which was significantly worse than patients with a low SUVmax (87.29%, P = 0.0004). The 5-year survival of patients with normal and high serum CEA level was 82.70 and 51.08%, respectively (P

A 85-year-old female with two lesions in left upper lobe (S1+2: 4.7 cm and S3: 1.5 cm) was diagnosed with pulmonary adenocarcinoma. Preoperatively, a mutation analysis of epidermal growth factor receptor (EGFR) gene resulted in negative one. A computed tomographic scan pointed out a contralateral small nodule (right S8: 1 cm) with bilateral multicentric ground glass opacities. Even though a very-elderly but a healthy IV-staged advanced lung cancer, she desired for receiving a multimodality therapy. Left upper lobectomy with mediastinal nodal dissection was preceded. Eventually, the postoperative pathology disclosed lung cancer with multiple pulmonary metastasis in the contralateral lobe (T3N2M1a, stage IV). An another detection method of EGFR gene mutation revealed a positive result of the resected specimen. A first-line adjuvant oral administration of erlotinib treatment had diminished the unresected multicentric lesions, which stable status have been maintained for more than 12 months. The first-line erlotinib therapy showed a dramatic response for the elderly patient with EGFR gene mutation-positive. A reliability and accuracy of the detection method should be important to select an appropriate treatment. In clinical practice of the selected population of advanced lung cancer with EGFR mutation-positive, combination therapy of aggressive surgical resection and erlotinib therapy might take advantage of extending the progression-free survival, in case of her no enough time in the rest life because of her very-elderly age.

A smoker, 55-year-old male with a small nodule in left S5 on computed tomographic (CT) scanning of chest was diagnosed with pulmonary adenocarcinoma (cT1N0M0, c-stage IA). However, the CT scanning revealed that several small nodules on pleural surface might suspect a pleural dissemination, that is, IV-staged advanced lung cancer. The patient desired for receiving an aggressive multimodality containing of surgery, immunotherapy, and gefitinib treatment. After thoracotomy, the small pleural nodules were intraoperatively diagnosed with pleural dissemination by pathological examination. However, there was no malignant pleural effusion and intraoperative cytological examination of intrathoracic lavage resulted in a negative finding. Because of clinical N2-negative disease without malignant pleural effusion, left upper lobectomy with mediastinal lymph nodes dissection was preceded. The postoperative pathological examination disclosed pulmonary adnocarcinoma with mixed subtypes (pT1N2M1a, p-stage IV) and with micropapillary pattern. A detection test of epidermal growth factor receptor (EGFR) gene mutation revealed a positive result (L858R). As a systemic therapy, a combination chemotherapy of gemcitabine and carboplatin was performed in 2 cycles for the remained pleural dissemination. The patient received combination therapy of gefitinib and interleukin-2 lymphokine-activated killer cell immunotherapy in 6 cycles. A CT scanning of chest displayed disappearances of the remained pleural dissemination. There had been uneventful for 25 months. On the third postoperative year, a stereotactic radiotherapy surgery was performed for small three brain metastases. He had been healthy and received the gefitinib treatment for 45 months without any regrowing of the irradiated cerebral metastases and the treated pleural dissemination. The combination therapy of gefitinib and immunotherapy in the postoperative early phase would take advantage of extending the patient's progression-free survival, and also in case of the selected population of the advanced lung cancer harboring a EGFR mutation-positive.

Bleeding from esophageal varices (EVs) or gastric varices (GVs) is a catastrophic complication of chronic liver disease. In this paper, we review the management of bleeding EVs and GVs. DIAGNOSIS OF EVS AND GVS: The grading system for esophagogastric varices proposed by the Japan Society for Portal Hypertension classifies GVs into those involving the cardia (Lg-c), the fundus (Lg-f), and both the cardia and the fundus (Lg-cf). In this review, we divide GVs into 2 categories: Lg-c (cardiac varices: CVs) and Lg-cf or Lg-f (fundal varices: FVs). TREATMENT MODALITIES FOR EVS AND GVS: Treatment modalities for EVs and GVs include placement of a Sengstaken-Blakemore tube, pharmacologic therapy, surgery, interventional radiology, and endoscopic treatment. MANAGEMENT OF BLEEDING EVS AND GVS: In Japan, endoscopic treatment has recently become the therapy of choice for bleeding EVs or GVs. In other countries, especially the United States, vasoactive drugs and endoscopic treatment are routinely used to manage variceal hemorrhage. BLEEDING EVS: Endoscopic variceal ligation is useful for controlling bleeding from EVs. However, confirmation of ligation precisely at the site of bleeding is usually difficult in patients with massive variceal bleeding. The site of acute bleeding can generally be identified by means of water instillation and suction. Ligation is then performed at the bleeding point. If endoscopic hemostasis is unsuccessful, a Sengstaken-Blakemore tube is used as a temporary bridge to other treatments. Transportal obliteration is useful for blocking variceal blood flow. BLEEDING GVS: Endoscopic injection sclerotherapy with a tissue adhesive, such as N-butyl-cyanoacrylate or isobutyl-2-cyanoacrylate, is effective for acute bleeding from GVs. However, bleeding from the GV injection site and rebleeding from the rupture point have been reported in patients receiving endoscopic injection sclerotherapy. If endoscopic hemostasis is unsuccessful, a Sengstaken-Blakemore tube is used as a temporary bridge to other treatments. Balloon-occluded retrograde transvenous obliteration and transportal obliteration are useful for the treatment of uncontrolled bleeding from GVs. PREVENTION OF RECURRENT VARICEAL HEMORRHAGE: Given the high recurrence rate, survivors of an acute variceal hemorrhage should receive treatment to prevent recurrence. Complete eradication of EVs or GVs and maintenance of low portal venous pressure are essential for preventing recurrence of variceal hemorrhage.

消化管間質腫瘍（gastrointestinal stromal tumor：GIST）の転移巣は肝臓が最も多く原発巣切除から2年以内に発生することが多い．今回，我々は術後12年目に切除しえた胃GIST肝転移と考えられた1例を経験した．症例は80歳男性．既往歴として12年前に胃粘膜下腫瘍に対して胃部分切除術を施行されていた．腹部CTにて肝右葉に75 mm大の辺縁不整，内部不均一な腫瘍を指摘された．造影超音波検査では動脈相にて腫瘍内に不規則に流入する血流を認め，Kupffer相では低エコー領域となった．転移性肝腫瘍，肝内胆管癌などが疑われ肝右葉切除術を施行した．病理所見にて腫瘍内部に紡錘形の核と細胞質を持つ細胞が不規則に索状を呈して増生しており，免疫染色にてc-kit，CD34陽性でありGISTの肝転移と診断された．12年前に施行された胃粘膜下腫瘍はGISTと推測され，本腫瘍は胃GIST肝転移であると考えられた．

A 62-year-old female with a productive sputum was pointed out of a mass of 2.5 cm in diameter in left S4 with lymphadenopathy of station 10, 4, and 3 on computed tomographic scan, which were heterogeneously enhanced by radiocontrast agent. She was diagnosed with pulmonary adenocarcinoma and clinical stage IIIA (T1N2M0, N2-multistation). First-line induction therapy of cisplatin plus paclitaxel had been performed but failed to respond to the chemotherapy. Second-line induction therapy of gefitinib for 6 months had showed the shrinkage of the tumor and resulted in a down-stage (T1N0M0, IA). Positron emission topography revealed no abnormal accumulations of the primary tumor and the mediastinal lymph nodes. As salvage surgery, left upper lobectomy was performed and the pathology revealed negative findings of metastasis in lymph nodal station 4, 5, 6, 7, and 11 but in a positive in station 10. The viable cells in the tumor had been residual (Ef.2) and diagnosed with stage IIA (pT1N1M0). Detection test of epidermal growth factor receptor gene mutation showed a negative result. The patient obtained 5-year's long-term survival without metastasis and recurrence. The combination therapy of gefitinib-induction therapy followed by surgery for advanced lung cancer with N2-multistation would have an advantage of good outcome for such patient in the limited gefitinib-responded population as tailor-made therapies.

The bzimpy iron(II) complexes, 1–3, containing branched long alkyl chains were synthesized and characterized in detail. The temperature-dependant magnetic susceptibility of 1 showed gradual spin crossover behavior from low spin to high spin state, while 2 retained only low spin state in the same condition. Interestingly, 3 displayed an abrupt spin transition in temperature range from T1/2↑ = 236 K to T1/2↓ = 230 K with the thermal hysteresis loop about 6 K. The differential scanning calorimetric analysis of 3 revealed two species of liquid crystal phase transitions at 236 K and 351 K, respectively.

In this review article we discuss the unique and novel magnetic properties for the cobalt(II) compounds with a variety of terpy derivatives including substituents at the 4-position. These are also compared with the unsubstituted terpy cobalt(II) complex. Since the first SCO cobalt(II) complex with terpy ligand was reported, this system has been widely studied. SCO cobalt(II) complexes possessing terpy or OH-terpy ligand reveal incomplete or gradual SCO behavior. The pyterpy-appended cobalt(II) complex shows SCO depending on the guest molecules involved. Cobalt(II) complexes with long-alkylated terpy ligands, [Co(Cn-terpy)2](BF4)2 (n = 16, 14 and 12) have been synthesized and some were characterized by single crystal X-ray analysis. Furthermore, variable-temperature magnetic susceptibility indicated that the non-solvated compounds [Co(Cn-terpy)2](BF4)2 (n = 16, 14 and 12) exhibit “reverse spin transition” phenomenon with wide thermal hysteresis around room temperature. In addition, the solvated compound [Co(C12-terpy)2](BF4)2·EtOH·0.5H2O shows “re-entrant SCO” behavior. The long alkyl chains in SCO cobalt(II) complexes can lead to novel physical properties resulting from a synergetic effect between SCO and response of the flexibility toward external stimuli.

Iron(III) spin-crossover compounds, [Fe(qnal)2]CF3SO3·MeOH (1·MeOH) and [Fe(qnal)2]CF3SO3·acetone (1·acetone) were prepared and their spin transition properties were characterized by magnetic susceptibility measurement, Mossbauer spectroscopy and single crystal analysis. Two iron(III) compounds exhibited abrupt spin transition with thermal hysteresis loop (T 1/2↑ = 115 K and T 1/2↓ = 104 K for 1·MeOH, and T 1/2↑ = 133 K and T 1/2↓ = 130 K for 1·acetone). Single crystal analysis revealed both of the structures in high-spin (HS) and low-spin (LS) states for 1·acetone. The difference of bond length between the HS and LS states for 1·acetone was ~0.10 A, which was corresponding to that of typical iron(III) SCO compounds. Specially, it showed strong intermolecular interactions by π–π stacking formed between the neighbor complexes leading to 2-D sheet. Both 1·MeOH and 1·acetone exhibited LIESST effect when it was illuminated at 1000 nm. We also confirmed that the introduction of strong intermolecular interactions, such as π–π stacking, can play an important role in LIESST effect.

The prognostic significance of the combined use of preoperative platelet count and serum carcinoembryonic antigen (CEA) level in non-small-cell lung cancer patients was investigated.Consecutive 289 non-small-cell lung cancer patients were reviewed retrospectively. Thrombocytosis was defined as a platelet count of at least 40 × 10(4)/mm(3).The frequency of preoperative thrombocytosis was 4.5% (13/289). The 5-year survival of patients with thrombocytosis was 30.77%, which was significantly poorer than that of patients with normal counts (68.65%, P = 0.0010). The 5-year survivals of patients with a normal CEA level and those with an elevated serum CEA level were 74.18% and 55.78%, respectively (P = 0.0019). Patients with both a normal platelet count and a normal serum CEA level had a favorable prognosis, whereas those with both thrombocytosis and elevated serum CEA level had a poor prognosis. The prognostic impact of the combined use of the platelet count and the serum CEA level was more significant than that of the platelet count or the serum CEA level alone. Both univariate and multivariate analyses indicated an independent prognostic impact of the combined use of platelet count and serum CEA levels.The combined use of preoperative platelet count and serum CEA levels might be useful for predicting the prognosis of non-small-cell lung cancer patients.

Background: This study evaluates the tumor marker index (TMI) based on carcinoembryonic antigen (CEA) levels in serum and pleural lavage fluid as a potential prognostic determinant for patients with non-small cell lung cancer (NSCLC). Materials and Methods: Three hundred and eighty-three consecutive NSCLC patients were re- viewed retrospectively. Results: The 5-year survival of patients with nor- mal and high serum CEA levels was 71.78% and 51.38%, respectively (p

Two hydatidiform moles and a choriocarcinoma as well as three normal chorionic villi (control) were examined by an immunofluorescence method in order to investigate the expression of HLA (A, B and C) antigens on trophoblastic tumor cells. In the hydatidiform moles, HLA antigens were absent from trophoblastic cells of the molar villus, but present on cells in villous stroma in a manner similar to those in normal chorionic villus. In the choriocarcinoma, HLA antigens were virtually negative. These findings are consistent with a hypothesis that trophoblastic tumor does not express HLA antigens.

Boosting an effective immune response against established tumors remains a difficult challenge. This study shows the combination of 1) adoptive cell transfer using CD25 depleted splenocytes co-cultured with irradiated tumor cells, and 2) antibody injection therapy using CTLA4 blockade, the elimination of Treg and OX40, which together could eradicate an established MethA tumor in over 50% of the BALB/c mice. Each element of the protocol was shown to be necessary, as elimination of any factor except anti-CD25 antibody injection failed to eradicate the tumor.

A shutterless continuous rotation method using an X-ray complementary metal-oxide semiconductor (CMOS) detector has been developed for high-speed, precise data collection in protein crystallography. The new method and detector were applied to the structure determination of three proteins by multi- and single-wavelength anomalous diffraction phasing and have thereby been proved to be applicable in protein crystallography., A new shutterless continuous rotation method using an X-ray complementary metal-oxide semiconductor (CMOS) detector has been developed for high-speed, precise data collection in protein crystallography. The principle of operation and the basic performance of the X-ray CMOS detector (Hamamatsu Photonics KK C10158DK) have been shown to be appropriate to the shutterless continuous rotation method. The data quality of the continuous rotation method is comparable to that of the conventional oscillation method using a CCD detector and, furthermore, the combination with fine ϕ slicing improves the data accuracy without increasing the data-collection time. The new method is more sensitive to diffraction intensity because of the narrow dynamic range of the CMOS detector. However, the strong diffraction spots were found to be precisely measured by recording them on successive multiple images by selecting an adequate rotation step. The new method has been used to successfully determine three protein structures by multi- and single-wavelength anomalous diffraction phasing and has thereby been proved applicable in protein crystallography. The apparatus and method may become a powerful tool at synchrotron protein crystallography beamlines with important potential across a wide range of X-ray wavelengths.

The prognostic significance of serum carcinoembryonic antigen (CEA) levels in non-small-cell lung cancer (NSCLC) patients with a normal serum CEA level (5.0 ng/ml) was examined.A total of 220 consecutive NSCLC patients with preoperative normal serum CEA levels were included. Patients were subdivided into two groups: preoperative serum CEA level/=2.5 and2.5 ng/ml.The 5-year survival of patients with preoperative serum CEA level less and more than 2.5 ng/ml were 79.62% and 62.0%, respectively (P = 0.0036). Multivariate analysis indicated that a preoperative serum CEA level of/=2.5 ng/ml was an independent prognostic factor. Similar results were found in patients with adenocarcinoma but not found in others.NSCLC patients with a high serum CEA level, especially adenocarcinoma patients, had poorer prognosis even if their serum CEA levels were within the normal upper limit.

Background/Aims: Nitric oxide synthase 2 (NOS2) is expressed during liver regeneration after a partial hepatectomy (PHx); NOS2 subsequently synthesizes nitric oxide (NO). However, the role of NOS2-synthesized NO in post-PHx liver regeneration remains unclear. We investigated the role of NOS2-synthesized NO in liver regeneration. Methods: NOS2 knockout (NOS2-KO) mice and control mice were subjected to PHx. Liver mass recovery and serum alanine aminotransferase (ALT) levels were then evaluated. The expressions of Ki-67 and single-strand DNA were also evaluated in remnant liver specimens. Differences in the gene expression profiles of the two groups of remnant liver specimens were analysed using a microarray and were validated using a reverse transcription-polymerase chain reaction (RT-PCR). Results: In NOS2-KO mice, liver regeneration was delayed and apoptosis and serum ALT levels were higher than the levels in the control mice. A microarray study and RT-PCR revealed that heat shock protein 70 family (HSP70 family), haeme oxygenase 1 (Hmox1), neuropilin 1 (Nrp1) and epidermal growth factor receptor (EGFR) were downregulated in NOS2-KO mice. Conclusions: NOS2-synthesized NO may improve hepatocyte viability through the induction of the HSP70 family and Hmox1 and may sensitize the remnant liver to growth factors through the induction of Nrp1 and EGFR post-PHx.

Nitrogen is one of the effective elements to enhance strength, corrosion resistance and austenite stability of stainless steel. Recently many studies have been conducted about nitrogen bearing austenitic, duplex and martensitic stainless steels. In this study, high nitrogen martensitic stainless steels containing 0.5C-0.2N, 0.3C-0.4N and 0.1-0.6N (; mass%) have been produced through the pressurized induction melting process. The hardness and corrosion resistance of the experimental steels have been investigated in various heat treatment conditions. The obtained results are as follows. (1) The maximum hardness of the steels after hardening with sub-zero treatment increases with carbon content, and the volume fraction of their retained austenite increases with nitrogen content. (2) In tempering process, all the steels show obvious secondary hardening at 723-773 K, and the maximum hardness increases with nitrogen content. Change in hardness of martensite after tempering at 723 K increases with [mass%N(in matrix)], ΔH723 K = 24.7 · [mass%N(in matrix)]-7.2 [HRC] where [mass%N(in matrix)] : nitrogen content in solid solution of as-quenched material. (3) The corrosion resistance of the steels after tempering is deteriorated with increasing tempering temperature. The steels containing more than 0.4 mass%N tempered under 723 K have corrosion resistance comparable with that of TYPE304 evaluated by pitting potential in 3.5 % NaCl aqueous solution.