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CD44+/ CD24+/ Ep CAM+ cells have been reported to be cancer stem cells in pancreatic cancer; however, the histological and clinical importance of these cells has not yet been investigated. Here we clarified the characteristics of CD44+/ CD24+/ Ep CAM+ cells in clinical specimens of pancreatic cancer using immunohistochemical assay. We used surgical specimens of pancreatic ductal adenocarcinoma from 101 patients. In view of tumor heterogeneity, we randomly selected 10 high-power fields per case, and triple-positive CD44+/ CD24+/ Ep CAM+ expression was identified using our scoring system. The distribution, histological characteristics, and prognostic importance of CD44+/ CD24+/ Ep CAM+ cells were then analyzed. As a result, the distribution of CD44+/ CD24+/ Ep CAM+ cells varied widely among the 101 cases examined, and CD44+/ CD24+/ Ep CAM+ expression was correlated with poor glandular differentiation and high proliferation. Survival analysis showed that CD44+/ CD24+/ Ep CAM+ expression was not correlated with patient outcome; however, CD44+/ CD24+ expression appeared to be correlated with poor prognosis. In conclusion, CD44+/ CD24+/ Ep CAM+ expression overlapped with poorly differentiated cells and possessed high proliferative potential in clinical pancreatic cancer. In particular, the presence of double-positive CD44+/ CD24+ expression seemed to have clinical relevance, associating with poor prognosis. [ABSTRACT FROM AUTHOR]

Background: The aim of the present study was to evaluate standard reference material (SRM) 1955 commutability as a reference material for serum folate using automated methods. We also designed so as to reduce the intermethod variability present in different automated methods. Methods: Using a microbiological assay related to the 'information value' of SRM 1955 as a comparison method, we investigated the possibility of standardization for the assay values of serum folate as measured by the automated methods (Access, Centaur and Elecsys). In the assay of 50 patient sera by these automated methods, we corrected observed values by the SRM 1955 and compared with comparison values. Results: The observed values of SRM 1955 Levels I, II and III were within or outside (but near) a 95% prediction interval obtained from patient sera by the automated methods. The normalized residuals obtained from SRM 1955 were within +3.0 (in SD units), which enabled us to conclude that the SRM 1955 had a physicochemical characterization similar to native serum. Twelve patients were assessed as hypofolataemia (,6.0 ng/mL) and 38 patients as normal (⩾6.0 ng/mL). Before correction, folate levels in six of 12 patients were lower than 6.0 ng/mL, and those in seven of 38 patients were higher than 6.0 ng/mL with the automated methods. After correction, low levels were found in four of 12 patients, and normal levels were found in 33 of 38 patients. Conclusions: The use of SRM 1955 would help to reduce the intermethod variability present in different automated methods for serum folate measurement. [ABSTRACT FROM AUTHOR]

The article focuses on the effects of transverse diaphragms and the level of transverse post-tensioning using unbonded carbon-fiber-reinforced-polymer (CFRP) on the side-by-side box beam bridges. It says that CFRP strands are suitable for prestressed concrete bridges in moderate to aggressive environments. It shows that increasing the levels of transverse post-tensioning forces proportionally increases the transverse strains for all points located along the post-tensioned diaphragms.

This paper presents the results of an experimental investigation on the flexural response of two identical box-beam bridge models reinforced and prestressed with different types of carbon fiber reinforced polymer (CFRP) tendons/strands. The first box-beam bridge model BBD-I was reinforced and prestressed using CFRP-DCI tendons, while the second bridge model BBC-I was reinforced and prestressed using carbon fiber composite cable (CFCC) strands. Each box-beam bridge model consisted of two precast prestressed box beams placed adjacent to each other and a CFRP/CFCC reinforced deck slab. The two box beams of each bridge model were prestressed using seven pretensioning tendons/ strands and consisted of four transverse diaphragms for transverse post-tensioning. Each box-beam bridge model was also prestressed using 12 longitudinal and four transverse unbonded post-tensioning tendons/strands. The changes in pretensioning forces during and after casting the box beams, ultimate loads and modes of failure, deflections, post-tensioning forces, strains, and energy ratios of both bridge models are presented in this paper. The average values of the measured transfer lengths of 9.5 mm (0.37 in.) diameter CFRP-DCI tendons and 12.5 mm (0.49 in.) diameter CFCC strands were measured as 27.4 times and 22.4 times the nominal strand diameter, respectively. As expected, both bridge models experienced similar failure modes, that is, the failure was initiated by the crushing of concrete in the compression zone followed by the immediate rupture of prestressing tendons/strands. Moreover, it was observed that the ultimate strength of Bridge Model BBD-I was higher and the energy ratio for the same was lower than that of Bridge Model BBC-I. However, the longitudinal unbonded post-tensioning tendons/strands of the two bridge models remained intact even after the complete collapse of the bridge models. In general, both Bridge Models BBD-I and BBC-I experienced identical flexural behavior, especially the cracking load, mode of failure, and variation in post-tensioning forces. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to understand the effectiveness of regular care in reducing the incidence of severe peristomal skin disorders, as well as to identify their risk factors., Summary Background Data: Peristomal skin disorders occur frequently in outpatient settings and require appropriate intervention. It remains, however, to be demonstrated when the need to follow up these patients decreases and whether assessing severity of peristomal skin disorders is useful., Methods: This prospective, multicenter, observational cohort study was conducted in six regional high-volume Japanese hospitals. The primary endpoint of the study was the effectiveness of regular follow-up in reducing the incidence of severe peristomal skin disorders via a scoring system at a defined regular outpatient visit. Propensity score matching was performed to compare a control group and patients with severe peristomal skin disorders., Results: In total, 217 patients between December 2019 and December 2021 were enrolled, and 191 patients were analyzed. Multivariate analysis showed that loop stoma (odds ratio [OR], 5.017; 95% confidence interval [CI], 1.350-18.639; P=0.016) and stoma height of <10 mm (OR, 7.831; 95% CI, 1.760-34.838; P=0.007) were independent risk factors for all peristomal skin disorders. After propensity score matching, the incidence of the disorders was not significantly different between the specified evaluation timing and historical control groups (75.7% vs. 77.2%, P=0.775), and the incidence of the severe disorders based on the ABCD and DET scores (5.9% vs. 19.1%, P<0.001 and 1.5% vs. 29.4%, P<0.001, respectively) was significantly lower in the specified evaluation timing group than in the historical control group., Conclusion: Regular peristomal skin disease follow-up and scoring, as well as appropriate stoma care at the stoma outpatient visit did not change the frequency of peristomal skin disease, but severe peristomal skin disorders were prevented. Additionally, risk factors for peristomal skin disorders were found to be height <10 mm and loop stoma., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Objectives: Surgical-site infections (SSIs) are the most common complication after stoma closure. We propose a new method for wound closure using the subcutaneous large-bite buried suture (SLBS) technique and a closed suction drain (CSD). In this study, we aimed to investigate the efficacy of a combination of the SLBS technique and a CSD to prevent superficial SSIs following stoma closure., Methods: We retrospectively analyzed patients who underwent stoma closure between January 2019 and July 2022. Primary closure of the stomal site was performed using the SLBS technique and a CSD for wound closure. The CSD was placed until postoperative day 7. The occurrence of superficial postoperative SSIs was also evaluated., Results: In total, 67 patients were included in the study. Within 30 days postoperatively, nine patients (13%) developed superficial SSIs. Considering the type of stoma, only 1 (2%) of 45 patients with ileostomy showed superficial SSIs, whereas 8 (36%) of 22 patients with colostomy showed superficial SSIs. Univariate analysis of the risk factors associated with the occurrence of superficial SSIs revealed that colostomy (p < 0.001) and hand-sewn anastomosis were significant risk factors (p = 0.019). Multivariate analysis of the risk factors associated with the occurrence of superficial SSIs revealed that colostomy was significant risk factor (p = 0.003)., Conclusions: This new method of stoma closure is feasible for preventing superficial SSIs, especially in ileostomy closure., Competing Interests: Conflicts of Interest There are no conflicts of interest., (Copyright © 2024 The Japan Society of Coloproctology.)

Background/aims: Mucosal adaptation of the ileum toward colonic epithelium has been reported in pouchitis in ulcerative colitis (UC); however, the clinical characteristics, endoscopic findings, and outcomes in patients with pouchitis with ileal mucosal adaptation are poorly understood., Methods: This was a single-center retrospective study comprising UC patients treated by proctocolectomy with ileal pouch-anal anastomosis who had undergone pouchoscopy at the University of Tsukuba Hospital between 2005 and 2022. Endoscopic phenotypes were evaluated according to the Chicago classification. High-iron diamine staining (HID) was performed to identify sulfomucin (colon-type mucin)-producing goblet cells (GCs) in pouch biopsies. We compared clinical data between patients with (high HID group) and without > 10% sulfomucin-producing GCs in at least one biopsy (low HID group)., Results: We reviewed 390 endoscopic examination reports from 50 patients. Focal inflammation was the most common phenotype (78%). Five patients (10%) required diverting ileostomy. Diffuse inflammation and fistula were significant risk factors for diverting ileostomy. The median proportion of sulfomucin-producing GCs on histological analysis of 82 pouch biopsies from 23 patients was 9.9% (range, 0%-93%). The duration of disease was significantly greater in the high HID group compared to the low HID group. The median percentage of sulfomucin-producing GCs was significantly higher in patients with diffuse inflammation or fistula compared to other endoscopic phenotypes (14% vs. 6.0%, P= 0.011)., Conclusions: Greater proportions of sulfomucin-producing GCs were observed in endoscopic phenotypes associated with poor outcomes in UC, indicating patients with pouchitis showing colonic metaplasia of GCs may benefit from early interventions.

CD44(+) /CD24(+) /EpCAM(+) cells have been reported to be cancer stem cells in pancreatic cancer; however, the histological and clinical importance of these cells has not yet been investigated. Here we clarified the characteristics of CD44(+) /CD24(+) /EpCAM(+) cells in clinical specimens of pancreatic cancer using immunohistochemical assay. We used surgical specimens of pancreatic ductal adenocarcinoma from 101 patients. In view of tumor heterogeneity, we randomly selected 10 high-power fields per case, and triple-positive CD44(+) /CD24(+) /EpCAM(+) expression was identified using our scoring system. The distribution, histological characteristics, and prognostic importance of CD44(+) /CD24(+) /EpCAM(+) cells were then analyzed. As a result, the distribution of CD44(+) /CD24(+) /EpCAM(+) cells varied widely among the 101 cases examined, and CD44(+) /CD24(+) /EpCAM(+) expression was correlated with poor glandular differentiation and high proliferation. Survival analysis showed that CD44(+) /CD24(+) /EpCAM(+) expression was not correlated with patient outcome; however, CD44(+) /CD24(+) expression appeared to be correlated with poor prognosis. In conclusion, CD44(+) /CD24(+) /EpCAM(+) expression overlapped with poorly differentiated cells and possessed high proliferative potential in clinical pancreatic cancer. In particular, the presence of double-positive CD44(+) /CD24(+) expression seemed to have clinical relevance, associating with poor prognosis., (© 2013 Japanese Cancer Association.)

We experienced the case that used S-1 for small intestinal cancer with peritoneal dissemination. A 51-year-old man admitted for fatigability and anemia. Small bowel series showed a stenosis lesion at the 15cm anal side from Treiz ligament, and the oral intestinal dilatasion was shown. CT showed the thickening of small intestinal wall and rectal wall. In addition, a rectal stenosis was shown by barium enema. It was diagnosed as small intestinal cancer with peritoneal dissemination, and an operation was performed. Peritoneal dissemination was recognized in the intraperitoneal whole, so jejunum partial resection was performed for primary cancer lesion. After an operation, internal use of S-1 was performed in an outpatient department. One course was assumed administration for four weeks and withdrawal for two weeks, and three courses was performed. There was not a side effect, and barium enema showed improvement of a rectal stenosis, and CT showed improvement of thickening of a rectal wall. A lesion worsened afterwards, and he died in postoperative six months.

Background: Much attention has been focused on the primary prevention of ischemic heart disease (IHD), but the prevalence and prognostic indicators of IHD remain unclear in healthy Japanese subjects., Hypothesis: The purpose of this study was to determine the predictors for the transition of IHD in healthy adult subjects using data from annual medical examinations., Methods: We analyzed clinical data on 2710 healthy subjects (1836 men and 874 women aged 26-76 years in 2000) who underwent medical examinations in both 2000 and 2002. Ischemic changes in the electrocardiogram (ECG) suggestive of IHD were defined as the existence of abnormal Q-wave and/or ST-T abnormalities without left ventricular high voltage. We assigned the subjects to two groups: the ischemic heart group (Group I), including subjects with normal ECG findings in 2000, followed by suspicious ischemic changes in the ECGs in 2002; and the normal group (Group N), including subjects with normal ECGs in both 2000 and 2002., Results: Fifty-nine subjects (2%, 20 women) were assigned to Group I and 2,538 subjects (96%, 810 women) were assigned to Group N. There were significant differences between the two groups in baseline age (Group I vs. Group N: 53 vs. 47 years, p < 0.001), body mass index (24 vs. 23 kg/m2, p = 0.036), systolic blood pressure (132 vs. 122 mmHg, p < 0.001), diastolic blood pressure (83 vs. 76 mmHg, p < 0.001), and fasting plasma glucose (109 vs. 96 mg/dl, p < 0.001). Fasting plasma glucose significantly increased in Group I (from 109 to 113 mg/dl, p = 0.034) during the study. Multivariate analysis showed significant differences in age (p < 0.001) and fasting plasma glucose (p = 0.0053)., Conclusion: Advanced age and relatively elevated fasting plasma glucose appeared to be significant predictors of ECG findings suggestive of IHD in normal subjects in the short period of 2 years.

A resected case of huge liver metastasis of hepatoid adenocarcinoma of the lung is described. A 77-year-old man who presented a solitary huge liver tumor was admitted to our hospital. He had undergone right lower lobectomy of the lung for lung cancer one year before. The view of imaging studies was not a typical one of hepatocellular carcinoma. Serum levels of AFP and PIVKA-II were 334,500ng/mL and 3,890mAU/mL, respectively, and the proportion of AFP L3 was 97.9%. It was thought that they were strongly diagnostic for hepatocellular carcinoma. Extended right lobectomy of the liver was performed. Microscopically, it was poorly differentiated adenocarcinoma and diagnosed as liver metastasis from the formerly resected lung cancer. The tumor was composed of cells with both sheet-like growth and tubule formation. The neoplastic cells, in the sheet-like growth resembled hepatocellular carcinoma cells. By immunohistochemical staining with anti-AFP and anti-PIVKA-II antibodies, cancer cells of both the primary and metastatic lesions were positive. The patient eventually died of multiple liver and bone metastasis 6 months after the operation.

Patients with xanthogranulomatous cholecystitis often undergo excessive surgical resections because of difficulty in distinguishing their condition from gallbladder cancer. Herein we present a patient with xanthogranulomatous cholecystitis mimicking stage IVA gallbladder cancer who underwent a hepatopancreatoduodenectomy. The 64-year-old man was admitted to the local hospital with a chief complaint of high fever, hypochondrolgia and jaundice. One month later, he transferred to Tsukuba University Hospital with a hard palpable fixed large tumor in the right hypochondrium. Computed tomography and ultrasonography showed a tumor originating from the gallbladder extending to the adjacent liver parenchyma, as well as nodes in the hepatoduodenal ligaments approaching the head of the pancreas. Endoscopic retrograde cholangiopancreatography failed to exhibit the gallbladder despite the visualization of irregular narrowing of the common hepatic duct. Angiography demonstrated encasement of the right hepatic artery and narrowing of the right portal vein. On the other hand, the level of serum carbohydrate antigen 19-9 was within normal range. Based on those findings, a right hepatic lobectomy with pancreaticoduodenectomy was conducted under the preoperative and intraoperative diagnosis of gallbladder cancer; stage IVA. The gross findings of the surgical specimen showed an ill-defined yellowish hard mass, but microscopic examination demonstrated xanthogranulomatous cholecystitis. The presented case shows that xanthogranulomatous cholecystitis can mimic an advanced gallbladder carcinoma when the severe chronic inflammatory changes have extended to the liver hilum down to the head of the pancreas. However, the normal level of tumor markers in all clinical courses might be a reason to consider xanthogranulomatous cholecystitis instead of gallbladder cancer. Even when the correct diagnosis is made, the possibility that the adjacent organs should be resected is not remote.