Current status in remnant gastric cancer after distal gastrectomy

Remnant gastric cancer(RGC) and gastric stump cancer after distal gastrectomy(DG) are recognized as the same clinical entity. In this review, the current knowledges as well as the non-settled issues of RGC are presented. Duodenogastric reflux and denervation of the gastric mucosa are considered as the two main factors responsible for the development of RGC after benign disease. On the other hand, some precancerous circumstances which already have existed at the time of initial surgery, such as atrophic gastritis and intestinal metaplasia, are the main factors associated with RGC after gastric cancer. Although eradication of Helicobacter pylori(H. pylori) in remnant stomach is promising, it is still uncertain whether it can reduce the risk of carcinogenesis. Periodic endoscopic surveillance after DG was reported useful in detecting RGC at an early stage, which offers a chance to undergo minimally invasive endoscopic treatment or laparoscopic surgery and leads to an improved prognosis in RGC patients. Future challenges may be expected to elucidate the benefit of eradication of H. pylori in the remnant stomach if it could reduce the risk for RGC, to build an optimal endoscopic surveillance strategy after DG by stratifying the risk for development of RGC, and to develop a specific staging system for RGC for the standardization of the treatment by prospecting the prognosis.

Prognostic significance of the lymphocyte-to-monocyte ratio in patients with metastatic colorectal cancer

AIM:To evaluate the prognostic significance of the lymphocyte to monocyte ratio(LMR) in patients with unresectable metastatic colorectal cancer who received palliative chemotherapy.METHODS:A total of 104 patients with unresectable metastatic colorectal cancer who underwent palliative chemotherapy were enrolled. The LMR was calculated from blood samples by dividing the absolute lymphocyte count by the absolute monocyte count. Pretreatment LMR values were measured within one week before the initiation of chemotherapy,while posttreatment LMR values were measured eight weeks after the initiation of chemotherapy.RESULTS:The median pre-treatment LMR was 4.16(range:0.58-14.06). We set 3.38 as the cut-off level based on the receiver operating characteristic curve. Based on the cut-off level of 3.38,66 patients were classified into the high pre-treatment LMR group and 38 patients were classified into the low pretreatment LMR group. The low pre-treatment LMR group had a significantly worse overall survival rate(P = 0.0011). Moreover,patients who demonstrated low pre-treatment LMR and normalization after treatmentexhibited a better overall survival rate than the patients with low pre-treatment and post-treatment LMR values.CONCLUSION:The lymphocyte to monocyte ratio is a useful prognostic marker in patients with unresectable metastatic colorectal cancer who receive palliative chemotherapy.

Inflammation-based factors and prognosis in patients with colorectal cancer

Several parameters for predicting survival in patients with colorectal cancer have been identified, including the performance status, age, gender and tumor-nodemetastasis(TNM) stage. Although the TNM stage is important and useful for predicting the prognosis and determining the appropriate treatment, it is well known that the survival time varies widely, even in patients with the same stage of disease. Therefore, the identification of new parameters capable of more precisely predicting patient survival is needed to help select the optimal treatment, especially in patients in the advanced stage of disease. Although the TNM stage reflects the tumor characteristics, cancer progression and survival are not determined solely based on the local characteristics of the tumor, but also the host systemic immune/inflammatory response. Therefore, using a combination of parameters that reflect both tumor characteristics and the host systemic inflammatory status is thought to be important for accurately predicting patient survival.

Prognosis following transcatheter arterial embolization for 121 patients with unresectable hepatocellular carcinoma with or without a history of treatment

瞄准：回顾地为 HCC 后面的 transcatheter 与肝细胞癌(HCC ) 评估病人的预后与或没有治疗的历史动脉的 embolization (TAE ) 。方法：有在我们的医院里从 1992 ～ 2004 与 TAE 对待的 HCC 的 121 个病人在这研究被注册。84 个病人为 HCC 有治疗的历史，当时 37。在入口，有额外肝的转移的病人，门静脉肿瘤血栓，或孩子呸班的时候， C 被排除。当 HCC 的复发被提高的肿瘤标记，或 ultrasonography 或动态计算断层摄影术调查结果诊断时， TAE 被重复。结果：肿瘤尺寸更大，没有过去的治疗(P【0.01 ) ，肿瘤的数字是在病人的少数。然而，在节点转移(TNM ) 舞台或幸存在 2 个组之间评估的肿瘤没有差别。一个双性人 alpha-fetoprotein (法新社)(】100 ng/mL ) 的小叶片的肿瘤和高水平是与在有 HCC 的历史的病人的差的预后有关的因素。结论：预后追随者 TAE 在有或没有过去的治疗的 HCC 病人之间是类似的。在到一堂重复 TAE 功课的入口能改进预后以前， HCC 或周期性的 HCC 和获得的好本地人的早诊断对 HCC 控制。

Doublecortin and CaM kinase-like-1 as an independent prognostic factor in patients with resected pancreatic carcinoma

AIM To elucidate the effect of expression of doublecortin and Ca M kinase-like-1(DCLK1) in patients with pancreatic ductal adenocarcinoma(PDAC). METHODS Tumor specimens were obtained from 136 patients with pancreatic cancer who had undergone resection without preoperative therapy between January 2000 and December 2013 at the Department of Surgical Oncology, Osaka City University. The resected specimens were analyzed for associations with clinicopathological data, including DCLK1 expression, epithelial mesenchymal transition(EMT) marker expression, and cancer stem cell(CSC) marker expression. Univariate and multivariate survival analyses were performed and we assessed the association between DCLK1 expression and clinicopathological factors, including the EMT marker and CSC marker.RESULTS In total, 48.5%(66/136) of the pancreatic cancer samples were positive for DCLK1. Patients with DCLK1-positive tumors had significantly shorter survival times than those with DCLK1-negative tumors(median, 18.7 mo vs 49.5 mo, respectively; P < 0.0001). Positive DCLK1 expression correlated with histological grade(P = 0.0290), preoperative CA19-9 level(P = 0.0060), epithelial cell adhesion molecule(Ep CAM) expression(P = 0.0235), and the triple-positive expression of CD44/CD24/Ep CAM(P = 0.0139). On univariate survival analysis, five factors were significantly associated with worse overall survival: histological grade of G2 to G4(P = 0.0091), high preoperative serum SPan-1 level(P = 0.0034), R1/2(P < 0.0001), positive expression of DCLK1(P < 0.0001) or CD44(P = 0.0245). On multivariate survival analysis, R1/2 [odds ratio(OR) = 2.019, 95% confidence interval(CI): 1.380-2.933; P = 0.0004] and positive DCLK1 expression(OR = 1.848, 95%CI: 1.2854-2.661; P = 0.0009) were independent prognostic factors. CONCLUSION DCLK1 expression was found to be an independent prognostic factor and it may play a crucial prognostic role by promoting acquisition of stemness.

Effectiveness of sub-maximal intermittent exercise on muscle glycogen depletion, PGC-1<i>α</i>and PDK-4 gene expression

Several metabolic gene expressions are regulated in concert with muscle glycogen status. We hypothesized that intermittent exercise performed at high but sub-maximal intensities with long recovery periods would induce a low glycogen state that would stimul- ate peroxisome proliferator-activated receptor-γ coa- ctivator-1α (PGC1-α) and pyruvate dehydrogenase kinase-4 (PDK-4) gene expression in muscle. Nine young human subjects performed two intermittent exercise sessions. One session consisted of 60 s cycling bouts at VO2max (IE100%), and the other session consisted of 75 s cycling bouts at 80% VO2max (IE80%). Twelve bouts of exercise were completed in both sessions with a 4 min rest between each bout. Muscle specimens were obtained at pre-exercise and immediately, 1.5 h and 3 h post-exercise. Muscle gly- cogen was significantly decreased after both sessions (IE100%, 94.1 ± 5.8 to 38.7 ± 5.5 mmol/kg w.w.;IE80%, 94.6 ± 9.1 to 53.3 ± 4.8 mmol/kg w.w.;both P α and PDK- 4 mRNA expression were significantly increased after exercise in both IE100% and IE80% (PGC-1α: ~3.7 and ~2.9-fold, respectively;PDK-4: ~11.1 and ~3.5-fold, respectively;all P 100% than in IE80% (P a and PDK-4 mRNA expression, suggesting that increasing exercise intensity contributes to muscle glycogen depletion and PDK-4 mRNA expression in human skeletal muscle.

Short Report: Association of IL-15 with Peripheral and Hepatic Insulin Sensitivity in Healthy Middle-Aged Men

Rodent study suggests that interleukin (IL)-15 administration enhances insulin sensitivity. Although it is well known that circulating levels of typical inflammatory markers (C-reactive protein [CRP] and IL-6) are positively associated with homeostasis model assessment-insulin resistance (HOMA-IR), there are no studies investigating the associations of other inflammatory markers including IL-15 with peripheral/hepatic insulin sensitivity in humans. The current study aimed to examine the relationship between the levels of adiopokines or inflammatory cytokines and insulin sensitivity in 8 healthy middle-aged men. Circulating levels of 10 insulin sensitizing adipokines or inflammatory cytokines (total adiponectin [APN], high molecular weight adiponectin [HMW-APN], IL-4, IL-5, IL-6, IL-8, IL-15, interferon [IFN]-γ, tumor necrosis factor [TNF]-α, and TNF-β) were measured. A stable-labeled frequently sampled intravenous glucose tolerance test was performed to assess peripheral () and hepatic () insulin sensitivity estimated by 2-compartment minimal model. The levels of 3 inflammatory cytokines (IL-4, IL-6, and IL-15) were significantly and inversely correlated with either and . The association between IL-15 and either or was significant even after adjusting for age and percent body fat (p < 0.01). The current study showed a possible inverse association between serum IL-15 level and peripheral/hepatic insulin sensitivity in healthy middle-aged males, independent of percent body fat;this association in humans warrants further study.