Preoperative sorting of circulating T lymphocytes in patients with esophageal squamous cell carcinoma: Its prognostic significance

AIM: To elucidate the immunologic parameters for the outcome of patients with malignant tumors, especially esophageal squamous cell carcinoma (ESCC) associated with high malignant potential. METHODS: Clinicopathologic features were compared between patients with lower and higher CD4 and CD8 values as well as CD4/CD8 ratio in peripheral blood. RESULTS: The survival rate of patients with higher CD4 value was significantly better than that in patients with lower CD4 value (P = 0.039). The survival rate of patients with higher CD8 value was significantly worse than that of patients with lower CD8 value (P = 0.026). Similarly, the survival rate of patients with higher CD4/ CD8 ratio was significantly better than that of patients with lower CD4/CD8 ratio (P = 0.042). Additionally, multivariate analysis demonstrated that lower CD8 and lower CD4/CD8 ratio were factors independently associated with worse prognosis of patients. CONCLUSION: All the immunologic parameters can predict the outcome of patients with ESCC.

Schwannoma mimicking pancreatic carcinoma:A case report

BACKGROUND Schwannoma of the pancreas is extremely rare.We report a case of pancreatic schwannoma that was difficult to distinguish from pancreatic carcinoma before surgery.CASE SUMMARY A 66-year-old male underwent a right-lobe hepatectomy for hepatocellular carcinoma.Post-surgical computed tomography showed a 10 mm long solid mass with ischemia,with no expansion into the main pancreatic duct.Upon magnetic resonance cholangiopancreatography,the tumor had high signal intensity in diffusion weighted images,consistent with pancreatic carcinoma.Endoscopic ultrasound(EUS)was performed to obtain more information about the tumor,and showed a 14 mm solid and hypoechoic mass in the pancreatic body.Contrast enhanced EUS revealed that the tumor showed a hyperechoic mass in the early phase,and the contrasting effect continuation was very short;findings also consistent with pancreatic carcinoma.Thus,we preoperatively diagnosed his condition as a pancreatic carcinoma and performed distal pancreatectomy with splenectomy.Microscopic examination showed that the tumor was in fact a benign schwannoma.Histology showed a proliferation of spindle-shaped cell in a vague fascicular and haphazard pattern,with palisading arrangement.CONCLUSION Schwannoma of the pancreas is very rare,however,clinicians should consider schwannoma as the differential diagnosis for pancreatic tumors.

Successful outcome of retrograde pancreatojejunostomy for chronic pancreatitis and infected pancreatic cysts:A case report

BACKGROUND Chronic pancreatitis occasionally requires surgical treatment that can be performed with various techniques.Often,this type of surgery presents with postoperative complications.We report a case of a successful retrograde pancreatojejunostomy for chronic pancreatitis and infected pancreatic cysts.CASE SUMMARY A 62-year-old male with a 10-year history of chronic pancreatitis presented with epigastric pain for one week and a 20 kg weight loss over one year.Computed tomography showed stones in the pancreas(mainly the head),expansion of the main pancreatic duct,and thinning of the pancreatic parenchyma.Magnetic resonance imaging showed infected pancreatic cysts connected to the stomach with a fistula from the splenic hilum to the caudal portion of the liver’s lateral segment.An endoscopic retrograde pancreatography was performed;the guide wires could not pass through the stones in the pancreas and therefore,drainage of the main pancreatic duct was not achieved.Next,a distal pancreatomy and splenectomy were performed;however,the pancreatic juice in the remaining parenchyma was blocked by the stones.Hence,we performed a retrograde pancreatojejunostomy and Roux-en-Y anastomosis.The patient had no postoperative complications and was discharged from the hospital on postoperative day 14.CONCLUSION A distal pancreatomy,retrograde pancreatojejunostomy,and Roux-en-Y anastomosis could be an effective surgical procedure for intractable chronic pancreatitis.

Importance of virological response in the early stage of telaprevir-based triple therapy for hepatitis C

AIM: To investigate the efficacy of virological response(VR) to telaprevir(TVR)-based triple therapy in predicting treatment outcome of hepatitis C.METHODS: This prospective, multicenter study consisted of 253 Japanese patients infected with hepatitis C virus(HCV) genotype 1b. All received 12 wk of TVR in combination with 24 wk of pegylatedinterferon-α(IFN-α) and ribavirin. Serum HCV RNA was tested at weeks 1, 2, 3, 4, 6, 8, 12, 16, 20, and 24. VR was defined as undetectable serum HCV RNA. Sustained virological response(SVR) was VR at 24 wk after the end of treatment and was regarded as a successful outcome.RESULTS: Of 253 patients, 207(81.8%) achieved SVR. The positive predictive value of VR for SVR was 100% at week 2, after which it gradually decreased, and was over 85% to week 12. The negative predictive value(NPV) gradually increased, reaching 100% at week 12. The upslope of the NPV showed a large increase from week 4(40.6%) to week 6(82.4%). There was a moderate concordance between the SVR and VR at week 6(kappa coefficient = 0.44), although other VRs had poor concordance to SVR. Multiple logistic regression analysis extracted VR at week 6(P < 0.0001, OR = 63.8) as an independent factor contributing to SVR. In addition, the interleukin-28 B single nucleotide polymorphism and response to previous pegylated-IFN-α and ribavirin therapy were identified as independent factors for SVR.CONCLUSION: VR at week 6, but not at week 4, is an efficient predictor of both SVR and non-SVR to TVRbased triple therapy.

Real-world Effectiveness and Tolerability of Interferonfree Direct-acting Antiviral for 15,849 Patients with Chronic Hepatitis C:A Multinational Cohort Study

Background and Aims:As practice patterns and hepatitis C virus(HCV)genotypes(GT)vary geographically,a global real-world study from both East and West covering all GTs can help inform practice policy toward the 2030 HCV elimination goal.This study aimed to assess the effectiveness and tolerability of DAA treatment in routine clinical practice in a multinational cohort for patients infected with all HCV GTs,focusing on GT3 and GT6.Methods:We analyzed the sustained virological response(SVR12)of 15,849 chronic hepatitis C patients from 39 Real-World Evidence from the Asia Liver Consortium for HCV clinical sites in Asia Pacific,North America,and Europe between 07/01/2014–07/01/2021.Results:The mean age was 62±13 years,with 49.6%male.The demographic breakdown was 91.1%Asian(52.9%Japanese,25.7%Chinese/Taiwan residents,5.4%Korean,3.3%Malaysian,and 2.9%Vietnamese),6.4%White,1.3%Hispanic/Latino,and 1%Black/African-American.Additionally,34.8%had cirrhosis,8.6%had hepatocellular carcinoma(HCC),and 24.9%were treatment-experienced(20.7%with interferon,4.3%with direct-acting antivirals).The largest group was GT1(10,246[64.6%]),followed by GT2(3,686[23.2%]),GT3(1,151[7.2%]),GT6(457[2.8%]),GT4(47[0.3%]),GT5(1[0.006%]),and untyped GTs(261[1.6%]).The overall SVR12 was 96.9%,with rates over 95%for GT1/2/3/6 but 91.5%for GT4.SVR12 for GT3 was 95.1%overall,98.2%for GT3a,and 94.0%for GT3b.SVR12 was 98.3%overall for GT6,lower for patients with cirrhosis and treatment-experienced(TE)(93.8%)but≥97.5%for tretment-naive patients regardless of cirrhosis status.On multivariable analysis,advanced age,prior treatment failure,cirrhosis,active HCC,and GT3/4 were independent predictors of lower SVR12,while being Asian was a significant predictor of achieving SVR12.Conclusions:In this diverse multinational realworld cohort of patients with various GTs,the overall cure rate was 96.9%,despite large numbers of patients with cirrhosis,HCC,TE,and GT3/6.SVR12 for GT3/6 with cirrhosis and TE was lower but still excellent(>91%).

Surgical Robot for Intraluminal Access:An Ex Vivo Feasibility Study

Early-stage gastrointestinal cancer is often treated by endoscopic submucosal dissection(ESD)using a flexible endoscope.Compared with conventional percutaneous surgery,ESD is much less invasive and provides a high quality of life for the patient because it does not require a skin incision,and the organ is preserved.However,the operator must be highly skilled because ESD requires using a flexible endoscope with energy devices,which have limited degrees of freedom.To facilitate easier manipulation of these flexible devices,we developed a surgical robot comprising a flexible endoscope and two articulating instruments.The robotic system is based on a conventional flexible endoscope,and an extrapolated motor unit moves the endoscope in all its degrees of freedom.The instruments are thin enough to allow insertion of two instruments into the endoscope channel,and each instrument has a bending section that allows for up–down,right–left,and forward–backward motion.In this study,we performed an ex vivo feasibility evaluation using the proposed robotic system for ESD in a porcine stomach.The procedure was successfully performed by five novice operators without complications.Our findings demonstrated the feasibility of the proposed robotic system and,furthermore,suggest that even operators with limited experience can use this system to perform ESD.