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Background Application of laparoscopic gastrectomy (LG) to advanced gastric cancer is still controversial due to lack of sufficient surgical and oncological outcomes. The purpose of this study was to elucidate the feasibility of LG for advanced gastric cancer by multicenter prospective cohort study. Methods A total of 98 patients with clinical stage II or III gastric cancer from 8 institutes were analyzed in this study. The primary endpoint was incidence of severe postoperative complications of Clavien-Dindo classification grade Ⅲa or higher. Results Sixty-six patients underwent laparoscopic distal gastrectomy (LDG), 10 patients laparoscopic proximal gastrectomy (LPG), 21 patients laparoscopic total gastrectomy (LTG), and 1 patient received gastro-jejunostomy. Seven patients had positive lavage cytology (CY1) and R0 rate was 90.8%. Three patients (3.1%) required conversion to open surgery. The incidence of overall postoperative complications and severe postoperative complications were 17.3% and 9.2%, respectively, those were comparable to the data of open surgery for advanced gastric cancer previously published. By surgical procedure, the incidence of severe postoperative complications of LDG, LPG, and LTG were 4.6, 0, and 28.6% and the rate of severe anastomotic leakage of LDG, LPG, and LTG were 0, 0, and 9.5%, respectively. Total gastrectomy was an only independent risk factor of severe postoperative complications in LG for advanced gastric cancer (odds ratio 8.75; 95% confidence interval 1.70-56.69, P = .0092). Discussion The incidence of severe postoperative complications after LG performed by qualified surgeons was acceptable even in cases of advanced gastric cancer; however, careful attention is required to adopt LTG. (UMIN000025733).

The appropriate surgical procedure for patients with upper third early gastric cancer is controversial. We compared total gastrectomy (TG) with proximal gastrectomy (PG) in this patient population. A multicenter, non-randomized trial was conducted, with patients treated with PG or TG. We compared short- and long-term outcomes between these procedures. Between 2009 and 2014, we enrolled 254 patients from 22 institutions; data from 252 were included in the analysis. These 252 patients were assigned to either the PG (n = 159) or TG (n = 93) group. Percentage of body weight loss (%BWL) at 1 year after surgery, i.e., the primary endpoint, in the PG group was significantly less than that of the TG group (− 12.8% versus − 16.9%; p = 0.0001). For short-term outcomes, operation time was significantly shorter for PG than TG (252 min versus 303 min; p

A patient was 70-year-old female. Because unknown fever following operation of left knee in December 20XX-1, abdominal simple CT was performed, diagnosed as cholecystitis and liver abscesses. However, her unknown fever did not improve with antibiotics therapy. Abdominal enhanced CT and MRI revealed to gallbladder cancer with liver invasion and metastases. These lesions were relatively localized in liver S4a/S5 and gallbladder, hepatoduodenal mesentery. Because unknown fever was exhausting, cholecystectomy, S4a+S5 hepatectomy with extrahepatic bile duct resection and lymph node dissemination were performed in January 20XX+1. In these pathological findings, there were moderate to poorly differentiated adenocarcinoma with squamous cell differentiation in almost area of gallbladder, diagnosed as adeno-squamous carcinoma with liver invasion and metastasis(pT3a[SI][H-inf], int, INF-β, ly1, v3, pn1, pN1, pM1, pStage ⅣB). One months after operation, abdominal CT revealed multiple liver metastatic recurrences. She died 7 months after operation. Although gallbladder adeno-squamous carcinoma has a poor prognosis, these many cases had a tendency to local infiltration accompanied with tumor fever. If curative resection might be obtained and the symptoms might be improved, aggressive resection should be performed.

A 69-year-old female underwent a mesh repair for an abdominal incisional hernia 4 years previously in our hospital. She visited local hospital for abdominal pain and fever. Abdominal CT showed a localizes abscess formation above the mesh, then she was taken to our hospital. We suspected mesh infection and performed emergent mesh removal. After the operation, we examined for her anemia. Her colonoscopy and CT findings pointed to transverse colon cancer. We performed right hemicolectomy, and final diagnosis was transverse colon cancer pT4aN0M0, pStage Ⅱb. She underwent adjuvant chemotherapy, and 9 months after surgery, no recurrence was found.

This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To evaluate the efficacy and safety of splenectomy in people undergoing total gastrectomy for gastric cancer.

A fibrillar-shaped metastable smectic phase forms during orientation-induced crystallization of poly(ethylene terephthalate). We investigated the effects of dimensions and regularity of the smectic phase on the mechanical properties by high-precision X-ray measurements. The drawing stress dependence was 76-168 MPa and the spinning speed dependence of 250-2000 m/min. The proportion, persistence length, and thickness of the smectic phase achieved their maximum values at 0.3-0.4 ms after necking. At this time g(II) also reached a minimum value of 3.7%-4.3%. The persistence length increased linearly with the natural draw ratio of as-spun fibers at less than 1500 m/min. The maximum values of the proportion, persistence length, and thickness showed no dependence on the drawing stress; however, the proportion and persistence length increased more rapidly. The increase of d-spacing with drawing stress led to an apparent elastic modulus of approximately 40 GPa for the oriented molecular bundle., Article, POLYMER.164:163-173(2019)

Most of us have seen robots in movies, animations and comic book stories, so the word “robot” tends to conjure up images of fictional robots rather than the real thing. The robots in Japanese cartoons such as Astro Boy and Doraemon have human-like social skills, and their physical abilities make it possible for them to live alongside humans without any difficulties. In reality, robots are quite different from these fictional creations. At least, the robots of the early 21st century are still unable to interact smoothly with humans (Norman, 2007). Due to the large disparity between the fictional image of robots and their actual appearance, people sometimes feel stressed when confronted with robots. To facilitate smoother interactions between humans and robots, we must not only to improve the intelligence and physical ability of robots, but also find some way of evaluating the psychological stress felt by humans when they have to interact with robots. To develop robots that can interact smoothly with humans, we need to be able to ascertain the psychological and physiological characteristics of humans by evaluating and analyzing the stress they experience in everyday activities, design robots based on human characteristics, and evaluate and study these robots. In short, stress evaluation is a key requirement for the realization of smooth interactions between robots and humans. In this chapter, we discuss methods for objectively evaluating and investigating the psychological stress that people experience when interacting with robots. For the evaluation of stress, we used acceleration pulse waveforms and the saliva constituents which are biochemical stress markers. These were used to evaluate the psychological stress of a surgeon using a surgical assistant robot. A surgical assistant robot is a robot that interacts with a surgeon and is situated in contact with the patients to provide support for surgical operations. Interaction with humans is of greater importance for surgical assistant robots than for any other type of robot. A

A 60's woman was admitted to our hospital because of palpitations that occurred with exertion. Coronary angiography computed tomography(CT)of suspected angina detected a tumor in the pancreatic head region. Abdominal CT showed a poorly enhanced 40×32 mm solid tumor in the hepatoduodenal ligament that contained a fatty component and calcification. During surgery, the tumor was located in the hepatoduodenal ligament, adhered to the pancreatic head, common hepatic artery, gastroduodenal artery, portal vein and common bile duct. However, the tumor was resected by preserving them. The tumor contained stratified squamous epithelium, a sebaceous gland, nerve, a pancreatic gland, and an adrenal gland. The histological diagnosis was a mature cystic teratoma. The patient showed no recurrence in 2 years and 10 months post-surgery. Mature teratomas in the hepatoduodenal ligament are extremely rare. Some reports showed that combined resection was performed when the tumor was in contact with the common bile duct, portal vein, and arteries. However, in our case, the tumor was removed relatively safely without combined resection.

A 50-year-old woman was admitted to our hospital due to intermittent epigastric pain and vomiting for 2 months. Contrast enhanced CT scan showed stenosis in the upper jejunum. She was diagnosed with small intestinal ileus. A small enteroscopy revealed a peripheral type 2 lesion in the upper jejunum, approximately 10 cm from the Treitz's ligament. Upon biopsy, she was diagnosed with a well-differentiated adenocarcinoma. A laparoscope-assisted extracorporeal operation was performed due to the ease of raising the umbilical wound. Swollen lymph nodes were found in the mesentery. A surgical margin of 5 cm on the oral side and 20 cm on the anal side was secured. We performed partial resection of the small intestine, including the mesentery with the enlarged lymph nodes. The histopathological diagnosis was a Type 2, 3×2 cm, tub2, pT4aN1aM0, pStage Ⅲb small intestinal cancer. Due to the development of small intestinal ileus, the small bowel cancer was diagnosed preoperatively. Hence, it was slightly we will report including the literature consideration of.

The patient was a 79-year-old woman. In January 20XX, upper gastrointestinal endoscopy revealed a duodenal tumor with bleeding and ulceration. This tumor was diagnosed as a duodenal neuroendocrine tumor(NET)based on biopsy findings. In March 20XX, the patient underwent pancreatoduodenectomy with lymph node dissemination. Based on these pathological findings, the tumor was diagnosed as a duodenal NET(G2)with a lymph node metastasis(T2, N1, M0, Stage Ⅲ). Twenty months after the operation, abdominal CT revealed multiple liver metastases(S4, S7, and S8). After this recurrence, she underwent the subcutaneous somatostatin analogue injection therapy every 28 days, and transarterial chemoembolization( TACE)when these recurrent tumors showed remarkable regrowth, once a year, accounting for her age. She has maintained good disease control for 5 years.

An 84-year-old woman with a chief complaint of right lower abdominal pain was admitted to our hospital in November 20XX. Abdominal CT scan revealed a 9.6×4.1 cm diameter low density area proximal to the 13 mm diameter appendix, which led to perforated appendicitis with a huge abscess. The patient underwent an open appendectomy with partial cecum resection. The appendix was found to be twisted by 540°. The pathological diagnosis was low-grade appendiceal mucinous neoplasm(LAMN). Recent research has found that the use of laparoscopic surgery for the treatment of LAMN has been increasing. Appropriate surgical intervention should be considered for LAMN because it is a borderline malignancy. Careful treatment with laparoscopic surgery might be considered as one of the treatment options for LAMN. We hope to accumulate more cases of LAMN to confirm our results.

A 78-year-old woman had undergone subtotal stomach-preserving pancreatoduodenectomy for acinar cell carcinoma (ACC)of the pancreatic head approximately 2 years before presentation, and the pathological diagnosis had been pT2pN0pM0, fStageⅠB(JPS 7th). Adjuvant chemotherapy was discontinued after 3 months because of side effects. Contrast- enhanced CT and PET-CT 2 years postoperatively revealed a tumor measuring 2 cm with a high concentration of FDG in the minor curvature of the stomach. During laparotomy, a 3 cm large lymph node was palpated in the minor curvature of the stomach, and a small lymph node was found adjacently. We diagnosed the patient with multiple lymph node recurrences and performed gastric lymph node dissection of the minor curvature. The pathological diagnosis was a single 2 cm large ACC lymph node metastasis. The patient did not consent to postoperative adjuvant chemotherapy and showed no recurrence for 1 year and 7 months postoperatively. Pancreatic ACC is a rare pancreatic tumor, and its clinicopathologic features are still largely unknown. In recent years, there have been reports of active resection or long-term survival with anti-cancer drug treatment even in recurrent cases, such as the present case. However, the indication and method of anti-cancer treatment are unclear and might need the accumulation of many more cases.

Body weight loss (BWL) after gastrectomy is associated with not only a deteriorated quality of life but also a poor prognosis. Oral nutritional supplements (ONS) may be used to minimize BWL, which is observed in the first 3 months after gastrectomy and becomes stable thereafter, although the results of several randomized trials remain controversial. We performed a multicenter, open-label randomized controlled trial including 1003 gastric cancer patients undergoing curative gastrectomy. Patients were assigned to the ONS group or the control group. In the former, 400 ml (400 kcal) per day for 12 weeks as enteral nutrition was planned, and the actual intake amount was recorded daily by patients themselves. The primary endpoint was BWL 1 year after gastrectomy. BWL data were available in 880 patients (ONS 437, control 443). BWL at 3 months was significantly lower in the ONS group than in the control group (7.1 ± 5.6% and 8.5 ± 5.8%, p = 0.0011). However, the difference gradually declined after 6 months and was not significant 1 year after surgery (9.3 ± 8.2% and 9.8 ± 8.7%, p = 0.37). In the ONS group, 50.4% of patients took more than 200 ml/day of ONS (average 301 ml) and showed significantly less BWL (8.2 ± 7.2%) at 1 year than the control (p = 0.0204). The administration of ONS for 12 weeks after gastrectomy did not improve BWL at 1 year. However, the improvement in BWL remained until 1 year after surgery in patients who took more than 200 kcal/day of ONS.

The Earth Clouds, Aerosols and Radiation Explorer (EarthCARE) is a Japanese-European collaborative earth observation satellite mission. The Cloud Profiling Radar (CPR) is one of the EarthCARE instruments and it is the world's first on-board millimeter-wave Doppler radar in space. The Japan Aerospace exploration agency (JAXA) is responsible for development of the CPR in this mission in cooperation with the National Institute of Information and Communications Technology (NICT). This paper mainly describes the development status and performance of EarthCARE CPR Proto Flight Model (PFM).

In December 20XX-1, abdominal enhanced CT of a 73-year-old female patient showed a 28mm-in-diameter pancreatic tail cancer with splenic venous invasion. She underwent neoadjuvant GEM/TS-1 combination chemotherapy but abandoned this chemotherapy due to melena and exanthema. She underwent a distal pancreatectomy with lymph node dissemination. In these pathological findings, the tumor was diagnosed as a pancreatic tail cancer with splenic venous invasion(T3, N0, M0, Stage ⅡA). She underwent adjuvant GEM chemotherapy, but she abandoned this chemotherapy due to exanthema and was managed with observation. In September 20XX, she had a postoperative bowel obstruction and was treated with natural light. However, she had a postoperative bowel obstruction again in July, 20XX+1. Fluoroscopic images revealed stenosis in the intestine located 170 cm from the nasal cavity. She underwent open surgery to manage the bowel obstruction. There was a peritoneal tumor with adhesion to each intestine serosa in 3 areas located 80 cm, 100 cm, and 150 cm from the Treitz ligament. Therefore, she underwent a small intestine resection and anastomosis 70 cm to 110 cm from the Treitz ligament. Pathological findings showed that there was a 3mm-in-diameter adenocarcinoma in this peritoneal tumor. In these findings, this final diagnosis was an adhesive intestinal obstruction caused by peritoneal metastasis. Curative resection for single peritoneal recurrent metastasis might be useful for prognosis prolongation.

Vestigial-like 3 (VGLL3) is a member of the VGLL family, whose members serve as cofactors for TEA domain–containing transcription factors (TEADs). TEADs promote tissue and tumor development together with the cofactors Yes-associated protein (YAP) and transcriptional coactivator with PDZ-binding motif (TAZ). Although VGLL3 is involved in tumor cell proliferation, its relationship with TEADs and YAP/TAZ remains largely unknown. To close this research gap, here we established tumor cells stably expressing VGLL3 and found that they exhibit enhanced proliferation. Notably, YAP and TAZ were inactivated in the VGLL3-expressing cells, coinciding with activation of the Hippo pathway, which suppresses YAP/TAZ activities. VGLL3 in combination with TEADs promoted expression of the Hippo pathway components large tumor suppressor kinase (LATS2) and angiomotin-like 2 (AMOTL2). VGLL3 was highly expressed in malignant breast tumor cells and osteosarcoma cells, and VGLL3 knockdown increased nuclear localization of YAP and TAZ. Knockdown of LATS2 or AMOTL2, as well as VGLL3 knockdown, repressed proliferation of breast tumor cells. Together, these results suggest that VGLL3 together with TEADs promotes cell proliferation by activating the Hippo pathway through LATS2 and AMOTL2, leading to YAP/TAZ inactivation.

A 57-year-old woman was diagnosed with advanced gastric cancer with bone marrow metastasis(cT4aN1pM1[MAR], pStage Ⅳ). After 18 courses of S-1 and cisplatin and 18 courses of ramucirumab and paclitaxel, the chemotherapy was stopped because of stenosis. We performed endoscopic metallic stent placement, but stenosis reappeared after a month. Subsequently, distal gastrectomy was performed as a palliative surgery. She had no complications and improved appetite, therefore, she resumed chemotherapy after 3 postoperative months and continued for 4 years and 9 months from the first visit. In general, gastric cancer with bone marrow metastasis has a poor prognosis, however, in this case, long-term survival was achieved with palliative surgery.

A 74-year-old man underwent distal gastrectomy for gastric cancer(CY1, fStage Ⅳ). About 18 months after surgery, abdominal CT scans revealed multiple lymph node metastases along the portal vein. Systemic chemotherapy was administered comprising a capecitabine/oxaliplatin(CAPOX)regimen. After 4 courses of chemotherapy, an adverse reaction of Grade 2 diarrhea and peripheral neuropathy occurred, although regression of the lymph node metastasis was confirmed. Ramucirumab was administered as the second-line regimen, but CT imaging revealed lymph node progression after several courses. Although irinotecan(CPT-11)was selected as the third-line chemotherapy, the lymph node progression remained uncontrolled. Nivolumab was selected as the fourth-line chemotherapy. After 23 courses, nivolumab immunotherapy induced a partial response to the lymph node metastasis. Nivolumab immunotherapy continues to be administered until now, 5 years after the operation. We experienced a case of lymph node metastasis from gastric cancer successfully treated with nivolumab chemotherapy.

Fibril-sized structures, which exhibit a density fluctuation of several tens to hundreds of nanometers, are important because they influence many properties of fibers and films, particularly the strength and thermal shrinkage of synthetic fibers. We analyzed the formation of fibril-sized structures after necking using ultra-small-angle X-ray scattering (USAXS), which enables observation of the void and craze formations. Continuous laser-heated drawing and undulator synchrotron radiation were adopted to measure the structural development of poly(ethylene terephthalate) (PET) and poly(phenylene sulfide) (PPS) fibers. Both fibers showed a clear increase in the meridional streak intensity just after necking and an increase in the equatorial streak after necking. These increases were distinctive for PPS. Moreover, a layer-lined streak appeared after necking only for PET. The intensity of the meridional streak increased with an increase in the draw ratio, whereas the intensity of the layer-lined scattering decreased with an increase in the draw ratio., Article, POLYMER JOURNAL.51(2):211-219(2018)

Reverse osmosis (RO) membranes are becoming popular as energy saving and environmentally friendly materials for the desalination of water. Toward the rational design of RO membranes, we performed contrast-variation neutron scattering measurements and atomistic molecular dynamics (MD) simulations on polyamide/water systems with various water contents and deuteration ratios. The experimental and computational structure factors showed good agreement for all the systems examined. The structure of the water-rich polyamide/water system obtained from MD calculation showed that the water clusters are well connected to each other, and a relatively large number of water molecules are present at a distance over 3 A from the polyamide. The partial radial distribution functions were calculated, and strong interactions were observed between water and the carboxyl group in polyamide. Thus, the water permeability of the RO membrane can be expected to improve when more carboxyl groups are introduced. In addition, the polyamide–polyamide interaction was found to be equal to or smaller than the polyamide–water interactions and relatively weak in the water-rich system. Reverse osmosis membranes have been playing a main role for the desalination of water in the world. Hydration structure of polyamide functional layer of the membrane was studied via neutron scattering and atomistic molecular dynamics simulations. Experimental and computational structure factors, S(Q), of the polyamide/water system showed good agreement. Water clusters in water-rich system were well connected to each other and formed channel-like structure. Polyamide–water interactions and polyamide-polyamide interactions, which are thought to be important to enhance the performance of the membranes, were examined in detail.

The effects of spinning conditions on fiber properties are not well explained by the fiber structures because the birefringence, crystallinity, and SAXS patterns are often similar. In this study, the effects on the fiber structure development of polyethylene terephthalate after necking was analyzed by simultaneous WAXD/SAXS measurements. An X-shaped SAXS pattern was observed for all fibers drawn at the minimum draw ratio. In contrast, by drawing under a drawing stress of 100 MPa, the strong diffraction of the smectic phase and an obviously larger long period less than 1 ms after necking were observed for fibers spun at 500-1500 m/min, while almost no smectic phase was observed for fibers spun at 2000 m/min. A higher crystallization rate and clear draw ratio dependence of crystallization rate were also observed for the fiber spun at 2000 m/min. The clear differences in structure development can explain their differences in tensile strength and thermal shrinkage. (C) 2017 Elsevier Ltd. All rights reserved., Article, POLYMER.116:367-377(2017)

Fiber properties are decided by its structure, and the structure are mainly formed in the fiber drawing process. In this study, the effects of the draw ratio on the fiber structure development of polyethylene terephthalate after continuous neck-drawing were investigated using simultaneous WAXD/SAXS measurements. Low-oriented amorphous as-spun fibers were drawn to a draw ratio of 3.0-4.5, at which the fiber can be stably neck drawn. WAXD and SAXS images were obtained up to 2.0 ms when the structure was mainly developed. The smectic (0010) diffraction intensity and long period increased with increasing draw ratio up to 4.2, and a larger (0010) diffraction d-spacing was observed at a draw ratio of 4.5. The results suggest that more fibrillar structures were formed with increasing draw ratio up to 4.2, and more constrained molecular bundles were formed at a draw ratio of 4.5. A larger amount of constrained fibrillar structures can bear a greater tensile force in tensile tests, therefore the drawn fibers have higher tensile strengths. (C) 2017 Elsevier Ltd. All rights reserved., Article, POLYMER.116:357-366(2017)

A70s man was admitted to our hospital complaining of chest discomfort. Endoscopic examination showed mucosal erythema and irregularity and an area unstained by iodine in the middle esophagus 21 to 41 cm from the incisors. The biopsy specimen showed moderately differentiated squamous cell carcinoma. An abdominal computed tomographic(CT)scan revealed swelling of the lymph nodes along the celiac artery and abdominal aorta. The patient was diagnosed with unresectable advanced esophageal cancer(cT2N4M0, cStage Ⅳa). Systemic chemotherapy was initiated using a regimen of 5-FU and cisplatin(FP). After 2 courses of chemotherapy, an abdominal CT scan showed reduction of the lymph node swelling along the abdominal aorta, but the lymph node swelling remained along the celiac artery. Therefore, chemoradiotherapy(CRT; FP plus RT 60 Gy/30 Fr at the main tumor and the swelling of lymph nodes along the celiac artery)was administered. An abdominal CT scan showed reduced swelling of the lymph nodes along the abdominal aorta and the celiac artery after CRT. In addition, FP chemotherapy was also administered. APET -CT scan showed no increased FDG up take in the main tumor and swollen lymph nodes after 2 courses of chemotherapy. The complete response(CR)has been maintained for 30 months without therapy.

A 71-year-old woman complained of melena, and laparoscopic right hemicolectomy was performed for advanced colorec- tal cancer. Pathological examination revealed pStage Ⅲa(RAS-positive)disease. After the operation, UFT/LV was administered. However, peritoneal recurrence was confirmed. We changed the chemotherapeutic regimen to CapeOX plus Bmab and capecitabine plus Bmab. After 5 years and 9 months, pulmonary metastasis was observed. Therefore, we again changed the chemotherapeutic regimen to biweekly XELIRI plus Bmab. After 43 courses, the patient had stable disease. During biweekly XELIRI plus Bmab therapy, Grade 4 neutropenia occurred, so we reduced the CPT-11 dose by 20%. After dose reduction the patient experienced no more Grade 3/4 adverse events. We experienced a case of colorectal cancer wherein biweekly XELIRI plus Bmab therapy contributed to disease control as second-line treatment.

Background. Visceral obesity is a risk factor for complications after gastrectomy in patients with gastric cancer. However, it is unclear whether postoperative complications decrease with preoperative reduction of visceral fat without the achievement of a nonobese state. This is because previous studies have performed categorical comparisons of obesity and nonobesity. The current study was performed to estimate the impact of the preoperative visceral fat area (VFA) as a continuous variable on postoperative complications after gastrectomy. Methods. Consecutive patients with gastric cancer who underwent curative gastrectomy between June 2006 and August 2017 at the Kyoto University Hospital were included in this retrospective study. The VFA at the level of the umbilicus was measured using preoperative computed tomography. The relationship between postoperative complications and VFA was investigated with univariate and multivariate analyses. Results. total of 566 patients were included in the study. Their mean VFA was 110 ± 58 cm2, and postoperative complications occurred in 121 patients (21.4%). The larger the VFA (2), the higher the incidence of postoperative complications (11%, 14%, 21%, and 38%, respectively, P<0.001). Multivariate logistic regression analyses showed that the VFA was associated with postoperative complications (odds ratio: 1.009, 95% confidence interval (CI): 1.004–1.013, P<0.001), with an incidence of postoperative complications that was 9% (95% CI: 4%–12%) higher for every 10 cm2 increase in the VFA. Conclusion. The incidence of postoperative complications after gastrectomy increases in proportion to an increase in the preoperative VFA.

A patient was 59-year-old female. She presented our hospital with weight loss, anorexia and lower abdominal bloating. Abdominal computed tomography(CT), gastrointestinal endoscopy, colonoscopy and duodenal fistulagram showed duodenal cancer or colon cancer with duodenocolic fistula and ovary metastasis. She underwent subtotal stomach preserving pancreatoduodenectomy and right hemicolectomy. In these pathological findings, tumor was diagnosed as a duodenal cancer with duodenocolic fistula. She was surviving 12 months after the last surgery. In cases of cancer with duodenocolic fistula, pancreatoduodenectomy with right hemicolectomy would be necessary for nutrition improvement and cancer treatment.

We report a case of chemotherapy with FOLFOXIRI plus cetuximab for liver metastasis of sigmoid colon cancer. The patient was a 40's man who was diagnosed with sigmoid colon cancer with liver metastasis. Colonoscopy revealed a type 2 tumor with stenosis in the sigmoid colon. He underwent sigmoidectomy under laparotomy, and after the operation, received 7 courses of chemotherapy with FOLFOXIRI plus cetuximab. The liver tumor was sufficiently reduced, and laparotomy and liver right lobectomy were performed. Histopathology revealed a modified, Grade 2 tumor regression. He has been followed for 1 year 4months after the operation.

Sarcopenia, characterized by loss of skeletal muscle mass, is recognized as a prognostic factor in patients with gastric cancer. However, wide variability exists in the cutoff values of muscle mass for defining sarcopenia across previous studies, and the best cutoff values to predict survival remain unknown. This study aimed to determine the optimal cutoff values for sarcopenia to predict survival in patients with advanced gastric cancer. Patients with clinical stage II/III gastric cancer who underwent gastrectomy at Kyoto University Hospital were included in the study. The cross-sectional area of skeletal muscle at the third lumbar vertebra level was measured using preoperative computed tomography scan. The skeletal muscle index (SMI) was calculated by dividing the area by height in meters squared. Five sex-specific cutoffs of SMI, which were significantly associated with prognosis in patients with gastric and nongastric cancers, were examined as a threshold to define sarcopenia. In the 177 eligible patients, the five cutoffs of SMI resulted in an incidence of sarcopenia between 6 (3%) and 114 (64%). The 5-year overall survival was 48% in patients with sarcopenia based on the cutoffs reported by Martin et al., compared with 68% in those without sarcopenia (p = 0.013). A multivariate regression model demonstrated that sarcopenia based on the cutoffs was significantly associated with overall survival (hazard ratio 2.00, 95% confidence interval 1.24–3.24, p = 0.005). The cutoff values reported by Martin et al. were optimal to predict survival in patients with advanced gastric cancer.

The patient was a 66-year-old man. Total abdominal gastrectomy and D2 dissection were performed for gastric cancer (cT3N0M0P0CYXH0, cStage II A). Pathological examination confirmed a diagnosis of Stage III C mucinous adenocarcinoma (pT4pN3pM0, pStage III C). He underwent adjuvant chemotherapy with TS-1(120mg/body). One year after adjuvant chemotherapy, anastomotic stricture was caused. Although it was not possible to point out recurrent lesions on the CT image, we strongly suspected that extrinsic compression around the anastomotic portion was due to peritoneal dissemination recurrence because of symptoms and marked tumor elevation. Therefore, TS-1(120mg/body)plus cisplatin(CDDP 60mg/m2)were administered as first-line therapy for advanced gastric cancer. TS-1 plus CDDP(SP)chemotherapy resulted in marked tumor reduction and improved symptoms. However, after 33 courses of SP chemotherapy, renal function was worse due to cisplatin; thus, docetaxel(DTX 70mg/m2)was administered as second line therapy. After 8 courses of DTX, peritoneal dissemination recurrence was diagnosed, and the patient was treated with irinotecan(CPT-11 150mg/m / 2), ramucirumab(RAM 8 mg/kg) plus paclitaxel(PTX 80mg/m2 day 1, 8, 15). However, the disease worsened. The side effect of SP therapy was renal dysfunction. Nonetheless, we experienced that long-term disease control could be achieved by administering chemotherapy under strict follow-up.

A 66-year-old man was admitted to our hospital complaining of dysphagia. Endoscopic examination showed type 1 tumor in the middle intrathoracic esophagus. The biopsy specimen showed moderately differentiated squamous cell carcinoma. Abdominal CT scan revealed the swelling of lymph nodes along the celiac artery. We diagnosed unresectable advanced esophageal cancer(cT3N4M0, cStage IV a). Systemic chemotherapy was initiated using a regimen of docetaxel, CDDP, and 5- FU(DCF). Abdominal CT scan indicated regression of the swelling lymph nodes after 3 courses. Subtotal esophagectomy with 3 field lymph nodes dissection was performed, because the bulky lymph node could not be resected. Histological effect of chemotherapy diagnosed from resected specimen was Grade 2. In summary, we experienced a case of esophageal cancer successfully treated with DCF chemotherapy followed by conversion surgery.

The effect of draw ratio, molecular weight, and sea-island conjugated spinning with a polystyrene component on the fiber structure development of PET during laser drawing was analyzed by in-situ measurements with a 0.1ms time resolution using an ultra-high luminance X-ray beam generated from a synchrotron equipped with an undulator. The fiber temperature increased from 120°C to 160–220°C during the structure development process. By drawing the higher molecular weight PET to a higher draw ratio, a larger amount of fibrillar smectic mesophase formed just after the onset of necking, and a more highly oriented crystal formed after the extinction of the smectic mesophase. Accordingly, fibers with higher strength and higher thermal shrinkage stress were obtained. On the other hand, by conjugated spinning with a PS component, the fiber temperature increased along with an increase in the drawing stress, but the stress applied to the PET component should have decreased. The amount of smectic mesophase formed by the conjugated-spinning process was drastically decreased, and no crystallization induction time was observed, unlike the other cases. Crystallization, particularly the growth of a lamellar crystal, was also promoted. Moreover, a higher Young's modulus, a higher yield stress, and a higher shrinkage stress were observed for the conjugated-spun and drawn fibers. Therefore, the fibrillar smectic mesophase seems to block the formation of the lamellar crystal. Furthermore, the resultant fibrillar structure tends to result in a higher strength, but a relatively lower modulus and yield strength of the fiber., Article, POLYMER. 79:37-46 (2015)

This paper investigates potential space options for mitigating the impact of tropical cyclones on cities and civilians. Ground-based techniques combined with space-based remote sensing instrumentation are presented together with space-borne concepts employing space solar power technology. Two space-borne mitigation options are considered: atmospheric warming based on microwave irradiation and laser-induced cloud seeding based on laser power transfer. Finally technology roadmaps dedicated to the space-borne options are presented, including a detailed discussion on the technological viability and technology readiness level of our proposed systems. Based on these assessments, the space-borne cyclone mitigation options presented in this paper may be established in a quarter of a century.

Pancreatic metastasis of colorectal cancer is uncommon and is often identified in later stages of cancer, thereby making resection more uncommon. We report a case oflong -term survival after resection of metachronous metastasis to the pancreas from primary sigmoid colon cancer. A 50-year-old female patient underwent a sigmoid colon resection and bilateral salpingo-oophorectomy for sigmoid colon cancer and metastatic ovarian cancer in 2007. She underwent partial lung resection for metastatic lung cancer twice. Four years and 11 months after the first operation, an isolated mass was identified in the pancreatic tail, and a distal pancreatectomy, splenectomy, left adrenal gland removal, and regional lymph node dissection were performed. The tumor stained negatively for cytokeratin 7 and positively for cytokeratin 20, resulting in a diagnosis of pancreatic metastatic cancer from sigmoid colon cancer. The patient is alive 3 years and 4 months after distal pancreatectomy. This suggests that curative resection is effective for metastasis of colorectal cancer to the pancreas, similarly to metastases to the liver and lung.