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The best palliation for double obstruction (duodenal obstruction with biliary obstruction) remains unclear. We aimed to compare outcomes of duodenal stenting (DuS) with gastrojejunostomy (GJ) and identify factors associated with survival time and time to recurrent biliary obstruction (TRBO).Patients who underwent DuS or GJ combined with biliary stenting for double obstruction due to unresectable malignancy were retrospectively enrolled.In total, 111 patients were included; 84 underwent DuS, and 27 underwent GJ. The weighted survival time of the DuS group was significantly shorter than that of the GJ group (86 days vs 134 days, P 0.01). Although the weighted TRBO was not significantly different between the two groups, when limited to patients with distal duodenal obstruction, the weighted TRBO was significantly longer in the DuS group than in the GJ group (207 days vs. 32 days, P 0.01). GJ for distal duodenal obstruction was identified as the factor with the highest hazard ratio and was associated with a shorter TRBO (hazard ratio 8.5, P 0.01).Regarding survival time, GJ should be considered the primary treatment for patients with double obstruction. However, for patients with distal duodenal obstruction, DuS should be considered because GJ may be a risk factor for a shorter TRBO.

Introduction: We previously developed a novel methylation assay, the combined restriction digital PCR (CORD) assay, consisting of treatment of DNA with methylation-sensitive restriction enzymes and droplet digital PCR. Methods: In this study, we assessed the diagnostic performance of serum methylated Homeobox A1 (mHOXA1) and methylated somatostatin (mSST) using the CORD assay in combination with CA19-9 for pancreatic cancer using serum samples from 82 healthy individuals, 13 patients with benign pancreatic disease, 3 patients with branched-duct intraductal papillary mucinous neoplasm, and 91 patients with pancreatic cancer. Results: For the single marker tests, sensitivity for all stages of pancreatic cancer, stage I cancer, and specificity were, respectively, 71.4%, 50.0%, and 94.9% for CA19-9; 51.6%, 68.8%, and 90.8% for mHOXA1; and 50.1%, 68.8%, and 94.9% for mSST. Those for the combined marker tests were, respectively, 86.8%, 81.3%, and 85.7% for combined mHOXA1 and CA19-9; 86.8%, 87.5%, and 89.8% for combined mSST and CA19-9; and 89.0%, 87.5%, and 85.7% for all three markers combined. Conclusion: The combination of mHOXA1 and mSST with CA19-9 appears to be useful to detect pancreatic cancer even at an early stage.

Interaction between odor and taste information creates flavor perception. There are many possible determinants of the interaction between odor and taste, one of which may be the somatic sensations associated with breathing. We assumed that a smell stimulus accompanied by inhaling or exhaling enhances taste intensity if the order is congruent with natural drinking. To present an olfactory stimulus from the identical location during inhalation and exhalation, we blocked the gap between the tube presenting the olfactory stimulus and the nostril. Participants breathed and ingested the solution according to the instructions on the screen and evaluated the solution’s taste intensity. Vanilla odor enhanced the sweet taste in both retronasal and orthonasal conditions when the order of stimuli was congruent with natural drinking, but it did not do so in either condition when they were incongruent. The results suggest that breathing is a determinant of odor–taste interaction. The methods of presenting olfactory stimuli used in this study were compared and discussed in relation to those used in previous studies. Odor-induced taste enhancement depends on the time order of smell with breathing and taste congruency in natural drinking. Taste enhancement was induced by odor in both conditions by minimizing differences in odor presentation between them.

The efficacy of endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) using a dedicated plastic stent has been reported.[1 2][1] We therefore describe a technical pitfall during EUS-HGS using the plastic stent. A 52-year-old man was admitted to our hospital with jaundice. He had undergone

Background/Aim: Gemcitabine (GEM) sensitivity can help select the appropriate treatment for pancreatic cancer. We examined the association between HSP27 expression and GEM sensitivity. Materials and Methods: A total of 19 patients with unresectable pancreatic cancer who underwent endoscopic ultrasonography-guided fine needle aspiration (EUS-FNA) were enrolled and treated with GEM alone. We measured the expression of heat shock protein 27 (HSP27) and phosphorylated HSP27(p-HSP27) in EUS-FNA samples and evaluated the effects of GEM treatment. Results: The rate of GEM resistance was significantly higher in patients who showed overexpression of p-HSP27 (p51.6% showed a significantly lower survival rate, and GEM was administered for a shorter period of time (p

// Shuhei Shinoda 1 , Seiji Kaino 1 , Shogo Amano 1 , Hirofumi Harima 1 , Toshihiko Matsumoto 1, 2 , Koichi Fujisawa 1 , Taro Takami 1 , Naoki Yamamoto 1 , Takahiro Yamasaki 2 and Isao Sakaida 1 1 Department of Gastroenterology and Hepatology, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan 2 Department of Oncology and Laboratory Medicine, Yamaguchi University, Graduate School of Medicine, Yamaguchi, Japan Correspondence to: Taro Takami, email: t-takami@yamaguchi-u.ac.jp Keywords: deferasirox; iron chelator; gemcitabine; pancreatic cancer; ribonucleotide reductase Received: March 10, 2017 Accepted: April 28, 2018 Published: June 19, 2018 ABSTRACT Objectives: Iron is an essential element for cell proliferation and growth processes. We have reported that deferasirox (DFX), an oral iron chelator, showed antiproliferative activity against pancreatic cancer cells. This study aimed to elucidate the effects of combination of gemcitabine (GEM), standard chemotherapy for pancreatic cancer, and DFX in vitro and in vivo . Results: GEM+DFX showed antiproliferative activity and induced apoptosis in pancreatic cancer cells in vitro . GEM+DFX suppressed xenograft tumor growth and induced apoptosis without any serious side effects compared with control, GEM, and DFX (average tumor volume: control 697 mm 3 vs GEM 372 mm 3 , p < 0.05; GEM 372 mm 3 vs GEM+DFX 234 mm 3 , p < 0.05). RRM1 and RRM2 protein levels were substantially reduced by DFX in BxPC-3 in vitro . Conclusion: GEM+DFX has significant anticancer effects on pancreatic cancer cell through RR activity suppression. Methods: BxPC-3, a human pancreatic cancer cell line, was used in all experiments. Cellular proliferation rate was measured using 3-(4,5-dimethylthiazol-2-yl)-5-(3-carboxymethoxyphenyl)-2-(4-sulfophenyl)-2H-tetrazolium, inner salt assay. Apoptosis was evaluated by flow cytometry and by measuring caspase 3/7 activity with luminescence assay. In the tumor xenografts in nude mice models, when five weeks after engraftment, drug administration began (day 0). After treatment for 21 days, the mice were sacrificed and the tumors were excised. Apoptotic cells in xenografts were evaluated by terminal deoxynucleotidyl transferase deoxyuridine triphosphate nick-end labeling assay. Protein levels of ribonucleotide reductase (RR) subunit 1 (RRM1) and RR subunit 2 (RRM2) in BxPC-3 cells were assessed by western blot in vitro .