Surgical Treatment of Gastroesophageal Junction Cancer

Although the incidence of gastroesophageal junction (GEJ) adenocarcinoma has been increasing worldwide, no standardized surgical strategy for its treatment has been established. This study aimed to provide an update on the surgical treatment of GEJ adenocarcinoma by reviewing previous reports and propose recommended surgical approaches. The Siewert classification is widely used for determining which surgical procedure is used, because previous studies have shown that the pattern of lymph node (LN) metastasis depends on tumor location. In terms of surgical approaches for GEJ adenocarcinoma, a consensus was reached based on two randomized controlled trials. Siewert types I and III are treated as esophageal cancer and gastric cancer, respectively. Although no consensus has been reached regarding the treatment of Siewert type II, several retrospective studies suggested that the optimal treatment strategy includes paraaortic LN dissection. Against this background, a Japanese nationwide prospective trial is being conducted to determine the proportion of LN metastasis in GEJ cancers and to identify the optimal extent of LN dissection in each type.

Promotion of international relations by a short-term program for international students / 医学教育

<p>Background: The center for international relations was established in 2007 and it has organized a program for accepting international students for short periods since 2009 to enhance internationalization at the medical school.</p><p>Methods: The number of inbound and outbound students, and the number of overseas medical schools with an Academic Agreement and a Memorandum of Understanding with our institution from 2008 to 2013 were counted, and the relevant achievements were evaluated.</p><p>Results: The number of inbound students increased from 0 in 2008 to 14 in 2013, and the number of outbound students also increased from 1 in 2008 to 12 in 2013. The number of overseas medical schools with an Academic Agreement and a Memorandum of Understanding also increased from 1 to 3. The number of scholarship applications to go overseas also increased from 2 to 12.</p><p></p><p>Discussion: Organizing a well-established program for inbound students probably contributed to developing the international environment within the school for both inbound and outbound students, and to enhancing discussion of student exchange with potential partner universities. The center for international relations has functioned as a hub for the students and relevant departments by centralizing information, which has markedly communication improved.</p>

Perspective beyond Cancer Genomics: Bioenergetics of Cancer Stem Cells

Although the notion that cancer is a disease caused by genetic and epigenetic alterations is now widely accepted, perhaps more emphasis has been given to the fact that cancer is a genetic disease. It should be noted that in the post-genome sequencing project period of the 21st century, the underlined phenomenon nevertheless could not be discarded towards the complete control of cancer disaster as the whole strategy, and in depth investigation of the factors associated with tumorigenesis is required for achieving it. Otto Warburg has won a Nobel Prize in 1931 for the discovery of tumor bioenergetics, which is now commonly used as the basis of positron emission tomography (PET), a highly sensitive noninvasive technique used in cancer diagnosis. Furthermore, the importance of the cancer stem cell (CSC) hypothesis in therapy-related resistance and metastasis has been recognized during the past 2 decades. Accumulating evidence suggests that tumor bioenergetics plays a critical role in CSC regulation; this finding has opened up a new era of cancer medicine, which goes beyond cancer genomics.

Factors Supporting Continuation of Recuperation at Home of a Respirator Wearing Patient / 日本農村医学会雑誌

Two years have passed since a patient who started to use the respirator for a tuberculosis sequela and chronic respiratory failure at home. During this period, the patient got several short-term admissions into the hospital. After his first discharge, the patient and his family felt anxiety about recupration at home. It was the first time for us to provide home care services to a respirator wearing patient. However, the shift to recuperation at home was realized as an understanding was reached between physicians who decided upon care home and the patient's wife who wished “to live with the husband together”. The patient is now playing a role as a father and as a husband, and he is leading a full life. In this study, the personal and familial circumstances of the patient, decision-making about home care and community support were analized. We coucluded that there were several important factors for successful recuperation at home:specification of contents of concrete medical support to a patient and a family;an immediate suitable action at the time of change of a patient's condition;taking periodic rests of a patient and a family;and a good family relationship.

Pleural Dissemination of Lung Cancer: CT Diagnosis / 日本農村医学会雑誌

Pleural dissemination of a tumor is one form of the extrapleural involvments of lung cancer. CT images of pathologically proved pleural dissemination of lung cancer in 18 patient were included in this study. CT features of (a) small nodular opacities in the interlobar area and/or thickening of interlobar fissure, and (b) irregular pleural surface of the chest wall were retrospectively reviewed. Fourteen of 18 cases (78%) showed interlobar abnormalities and nine cases (50%) demonstrated irregular pleural surface of the chest wall. We concluded that CT scanning could play an important role in the clinical diagnosis of pleural dissemination of lung cancer.