Search

309 Background: Non-anticancer drugs such as metformin or statin are reported to have a potential role in cancer treatment and we previously reported inhibition of renin-angiotensin system (RAS) by angiotensin converting enzyme inhibitors (ACEI) or angiotensin receptor blockers (ARB) lead to better prognosis in PaC receiving gemcitabine (Br J Cancer 103: 1644-8). The relation between diabetes (DM) with its medication and the incidence of PaC has been described but its impact on prognosis is still unclear. Methods: We retrospectively reviewed 250 pts with advanced PaC receiving chemotherapy with gemcitabine and/or S-1 between June 2001 and April 2011 with a median follow up of 9.9 months (Mo). Univariate and multivariate analyses of progression-free survival (PFS) and overall survival (OS) were performed in pts with and without DM, using age, gender, BMI, PS, stage, protocol, DM with its treatment, hypertension (HT) with its treatment, and use of statin as variables. Results: DM was diagnosed in 124 pts (49%) and was treated with insulin or insulin analogs (n = 59), sulfonylurea (n = 38), biguanide (n = 8), thiazolidinedione (n = 6), and alpha-glucosidase inhibitor (n = 5). Statin was used in 16 pts with DM and 14 pts without DM. Locally advanced disease (44% vs. 29%) and HT (44% vs. 28%) were more prevalent in pts with DM. PFS (6.3 vs. 4.9 Mo, P = 0.440) and OS (13.3 vs. 10.0 Mo, P = 0.084) was longer in pts with DM, though not significantly. Use of statin in pts with DM was associated with longer PFS (11.6 vs. 6.0 Mo, P = 0.034) and longer OS (25.4 vs. 11.3 Mo, P = 0.006), while PFS and OS did not differ by the use of statin in pts without DM. Multivariate subgroup analysis with and without DM showed metastatic disease (Hazard ratio [HR] 2.11, P = 0.001 and HR 1.57, P = 0.013), PS 0-1 (HR 0.08, P Conclusions: In our retrospective analysis, use of statin in pts with DM as well as inhibition of RAS was associated with better prognosis in pts with PaC receiving chemotherapy.

Topographies of Si 220 reflection in the Bragg mode have been observed from a weakly bent single crystal. When bending is very weak, a novel interference fringe is observed instead of mirage diffraction fringes. The period of this fringe increases with the distance between the incident point of X-rays and the exit point of the diffracted beam. This interference fringe is caused by the interference between a mirage diffraction beam and the reflected beam from the bottom surface. When this interference fringe is observed, the interference fringes are also observed from the lateral surface even when the distance from the incident point to the crystal edge is 12 mm; X-rays propagate over a long distance, i.e., over a centimeter distance in the crystal.

A novel two-beam X-ray interferometer using two multiple Bragg–Laue (MBL) mode interferometers has been developed. The first MBL interferometer was utilized not only as a monochromator to generate a highly coherent beam but also as a beam splitter. The second MBL interferometer was used as an analyzer. By using this two-beam X-ray interferometer, interference fringes were observed as a function of the thickness of a phase plate inserted in one path of incident X-rays. The visibility of the measured fringes is approximately 25%. Some advantages of this MBL interferometer are pointed out.

Background Pancreatitis is one of complications after self-expandable metal stent (SEMS) placement. The purpose of this study was to evaluate risk factors for pancreatitis after endoscopic SEMS placement for malignant biliary obstruction (MBO).

Gemcitabine chemotherapy has been the standard for advanced pancreatic cancer for more than a decade. New oral fluoropyrimidines such as S-1 and capecitabine are other key drugs. Gemcitabine plus erlotinib was the only combination therapy that significantly prolonged survival, although the effect was minimal. Little or no improvement in survival with recent molecular-targeted drugs might be attributed to the very high incidence of K-ras gene mutation in pancreatic cancer. Recently, the non-gemcitabine-based-regimen of FOLFIRINOX showed significantly greater overall survival compared with gemcitabine for the first time. For biliary tract cancer, gemcitabine plus cisplatin combination chemotherapy has been proved to significantly prolong survival and will become the standard therapy. Further improvement in survival is expected by the addition of cetuximab.

Endoscopic self-expandable metal stent (SEMS) placement has become a standard palliative therapy for patients with malignant biliary obstruction. Acute cholecystitis after SEMS placement is a serious complication. We report a patient with an acute cholecystitis after covered SEMS placement, who was managed successfully with endoscopic transpapillary gallbladder drainage (ETGBD) and replacement of the covered SEMS. An 85-year-old man with pancreatic cancer suffered from acute cholecystitis after covered SEMS placement. It was impossible to perform percutaneous transhepatic gallbladder drainage. After removal of the covered SEMS with a snare, a 7Fr double pigtail stent was placed between the gallbladder and duodenum, subsequently followed by another covered SEMS insertion into the common bile duct beside the gallbladder stent. The cholecystitis improved immediately after ETGBD. ETGBD with replacement of the covered SEMS thus proved to be effective for treatment of patients with acute cholecystitis after covered SEMS placement.

膵石症に対する内視鏡治療において，併存する主膵管狭窄を治療することにより，膵炎や疼痛などの再発を予防し得るかは明らかでない．そこで，当施設で治療を行った膵石症61例について，症状の再発に寄与する因子を検討するとともに，膵管狭窄が症状の再発に及ぼす影響，膵管狭窄に対するステント治療による症状再発の予防効果について検討した．膵管狭窄は41例に合併し，24例に対してステントを留置した．平均観察期間3.3年で症状の再発を28例（46%）に認め，病悩期間が長いほど，症状再発のリスクは高くなった．膵管狭窄による症状再発のリスクは2.3倍（p=0.12），ステント留置による症状再発のリスクは0.35倍（p=0.057）であり，ステント治療の有用性が示唆された．一方で，留置中に13例（54%）に少なくとも1回の膵炎を合併しており，安全な留置法や留置期間などについては十分な検討が必要である．

By measuring X-rays from a bent Si single crystal, we have observed the amplification of the reflected beams from the surface. The amplification is observed when the incident angle is adjusted to minimize the effective linear absorption coefficient due to the dynamical diffraction effect. When we increase the width of the incident X-rays along the incident azimuth, we observe on increase in reflected beam intensity. The amplification can be explained by the addition of the electric fields of the propagating beams along hyperbolic trajectories in the bent crystal to those of the reflected beams.

based cytology in differentiating mucinous versus nonmucinous PCL. Methods: MEDLINE, SCOPUS, Cochrane, and CINAHL Plus databases were used to identify studies in which results of EUS-FNA based cytology of a pancreatic cyst were compared with the results of an acceptable criterion standard, including surgical biopsy or surgical excision histology of a pancreatic cyst. Two independent reviewers extracted the standardized data. The DerSimonian-Liard random effects model was used to estimate the pooled sensitivity, specificity, likelihood, and diagnostic odds ratio (DOR). A summary receiver operating characteristic (SROC) curve was also constructed. All potential sources of heterogeneity amongst the studies were explored by subgroup and meta-regression analyses. Results: A total of 701 patients with EUS-FNA cytology of PCL were examined from 14 distinct studies that satisfied our inclusion criteria. The pooled sensitivity of EUS-FNA based cytology in diagnosing mucinous cystic lesions (MCL) was 0.65 (95% CI, 0.59-0.70) and pooled specificity was 0.92 (95% CI, 0.89-0.95). The positive likelihood ratio for diagnosing MCL by EUS-FNA based cytology was 4.93 (95% CI, 1.35-18.08) and the negative likelihood ratio was 0.46 (95% CI, 0.27-0.80). The area under the curve (AUC) was 0.87. The P value for X2 heterogeneity for all the pooled estimates was >.05 suggesting significant heterogeneity amongst the studies. Heterogeneity is probably caused by factors that were inadequately reported in primary studies and, therefore, could not be explored in this meta-analysis. Conclusion: EUS-FNA based cytology has overall low sensitivity but excellent specificity in differentiating mucinous versus non-mucinous pancreatic cystic lesions. Thus EUS-FNA based cytology should be the investigation of choice to exclude the possibility of mucinous cystic lesion while evaluating pancreatic cystic lesions. The combine role of EUS morphology, FNA based cytology, and cyst fluid analysis for potential molecular markers needs further investigation.

X-ray interference fringes in diffraction beam from side surface of a thin plane-parallel crystal in Bragg–(Bragg) m –Laue case are measured and analyzed by using Wagner's approach. The origin of the interference fringes is explained by interference between the diffraction beam in Bragg–Laue case and that in Bragg–Bragg–Laue case. A part of the beams from side surface cannot be explained by the interference effect, but can be explained by the effect of confined beam.

An angular velocity detector includes an angular velocity detecting element having a vibrating body arranged in a base substrate to be vibrated on a surface horizontal with respect to the base substrate. The angular velocity detecting element detects an angular velocity around an axis perpendicular to the base substrate based on a vibration of the vibrating body. In the angular velocity detector, a circuit substrate is bonded to a first surface of the base substrate through an adhesive, and a second surface of the angular velocity detecting element is electrically connected to the circuit substrate through a bonding wire. Furthermore, the adhesive is partially arranged on the first surface of the base substrate at least at a portion corresponding to a bonding portion of the bonding wire on the second surface of the base substrate. Therefore, a wire bonding can be easily accurately performed.

A vibration type angular velocity sensor includes: a first and a second angular velocity sensors; and an anomaly monitoring signal generating and outputting unit including an opposite phase waveform synthesis portion. The first and the second angular velocity sensors include: a vibrator; a vibration driving unit; and a detection waveform generation unit. The opposite phase waveform synthesis portion synthesizes the first and the second detection waveforms with opposite phase. The anomaly monitoring signal generating and outputting unit generates and outputs an anomaly monitoring signal on the basis of a synthesized opposite phase waveform synthesized from the first and the second detection waveforms.

Background: During endoscopic retrograde cholangiopancreatography (ERCP), hyoscine-N-butylbromide (Buscopan) or glucagon is used to inhibit duodenal motility. However, they may cause adverse effects. Peppermint oil has an antispasmodic effect and is used as a less hazardous antispasmodic during colonoscopy and upper gastrointestinal endoscopy. The purpose of the present paper was therefore to investigate peppermint as an antispasmodic for ERCP. Methods: Forty patients were enrolled prospectively. They were assigned to four groups according to the peppermint oil concentration and site of administration: group 1, 20 mL of 1.6% solution around duodenal papilla; group 2, 20 mL of 1.6% solution both to the antrum of the stomach and around the duodenal papilla; group 3, 20 mL of 3.2% solution around the duodenal papilla; and group 4, 3.2% solution both to the antrum and around the duodenal papilla. Glucagon or hyoscine-N-butylbromide was added when duodenal peristalsis was not adequately diminished. Sixteen patients undergoing ERCP with glucagon were employed as historical controls. Results: The ERCP was attempted in all except one patient in group 2 who had bleeding from invaded tumor to the duodenum. Peppermint administration equally reduced duodenal motility in the groups. Duodenal movement was none or mild in 69.2% of patients. The ERCP was successfully performed with peppermint alone in 91.4% of patients (37/39). Glucagon or hyoscine-N-butylbromide was needed in one patient each in groups 1 and 4. Serious complications related to peppermint oil did not occur. Inhibitory effect of peppermint appears to be identical to that of glucagon. Conclusion: Duodenal relaxation was obtained with 20 mL of 1.6% peppermint oil solution in the duodenum, but additional administration may be required. Peppermint oil is useful as an antispasmodic agent for ERCP.

Inward and Outward Migration of Covered Metallic Stent in Patients with Unresectable Malignant Distal Biliary Obstruction Hiroyuki Isayama, Yousuke Nakai, Osamu Togawa, Toshihiko Arizumi, Saburo Matsubara, Hiroshi Kogure, Yukiko Ito, Natsuyo Yamamoto, Naoki Sasahira, Kenji Hirano, Takeshi Tsujino, Nobuo Toda, Yutaka Komatsu, Minoru Tada, Haruihiko Yoshida, Takao Kawabe, Masao Omata Background & Aim: Endoscopic or transhepatic biliary stenting has become widely accepted as a standard procedure for palliation of jaundice in patients with malignant biliary obstruction. Recently, various types of metallic stents, including polyurethane-covered Wallstent (PCW), polyurethane-covered Diamond stents (PCD) and silicone covered-Wallstent (SCW), are available. We have reported that covered metallic stents have longer patency to prevent tumor ingrowth (Gastrointest Endosc 2002, Gut 2004). More recently, however, disadvantages characteristic of those stents are noticeable. Of those, stent migration is one of the most common and serious ones. Therefore, we conducted the present study to elucidate the clinical features in cases with migration. Patients & Methods: From August 1997 to August 2004, we managed 180 patients with unresectable malignant distal biliary obstruction treated with covered metallic stent (pancreatic cancer 109, bile duct cancer 34, gallbladder cancer 7, papillary cancer 8 and metastatic nodes 22). PCW, PCD and SCW were used in 21, 57 and 102 patients, respectively. Their Medical records were retrospectively reviewed. We defined the stent migrated above the stricture was ‘‘inward migration’’ and distally migrated into the duodenum was ‘‘outward’’. Results: Twenty patients developed migration 2.5 months in mean after stent insertion. Nine had inward migration and 11 outward. All the patients with inward migration were accompanied by cholestasis or cholangitis. Inward migration seems to be mainly due to inappropriate designing of stent length and placement site. Stents were more shortened than expected. On the other hand, among 11 patients with outward migration, none showed cholangitis or cholestasis. The migration was accidentally found by follow-up abdominal X-ray. Nine with outward migration had favorable response to anticancer. Of those, 4 did not show symptoms even after stent was detached. Conclusions: Inward migration was associate serious symptomatic complications such as cholangitis. However, this type of migration may be avoided by directing careful attention to designing stent length and placement site. On the other hand, outward migration occurred in patients with favorable response to anticancer treatment and might not lead to more serious condition.

[Results] The n~*mber of survived PC ceils were signif*cantly smaller in I+TU M+TL compared with VTL, M-TL The PCNA-posinve ratio of adherent cells on chamber slides were sigraficantIy stnaller in I+TL, M+TL compared with I-TL, M-TL. IFN-gamma level was higher in I + TL and M + TL (I + TL > M + TL) compared with I-TL and M-TL. VEGFA level `*,as the lowest in I + TL group. [Conclusionl Our data showed that immunntherapy with DCs had anti-cancer effect in vitro. Data also indicated that the combination of tumor lysate pulsation and using immature DCs was the most dfective for human pancreatic cancer. The mechanistns of immunotherapy may not only be stimulating IFN-gamma production from T cells, but also attenuating the production of angiogenic factors.