Enhancement of Cr(VI) ion adsorption by two-step grafting of methacrylamide (MAAm) and 2-(dimethylamino)ethyl methacrylate (DMAEMA) onto polyethylene plate.

Polyethylene (PE) plates grafted with a neutral hydrophilic monomer, methacrylamide (MAAm), and a cationic monomer, 2-(dimethylamino)ethyl methacrylate (DMAEMA), (PE-g-PMAAm)-g-PDMAEMA plates, were prepared by the two-step photografting. The Cr(VI) ion adsorption of the resultant (PE-g-PMAAm)-g-PDMAEMA plates was investigated as a function of the initial pH value, temperature, and grafted amounts of PMAAm and PDMAEMA. The adsorption capacity of the (PE-g-PMAAm)-g-PDMAEMA plates had the maximum at the initial pH value of 3.0 and the initial adsorption rate increased with the temperature and increased with the amount of grafted DMAEMA. This result suggests that protonated dimethylamino groups present in the inside of the grafted layer are increasingly involved in the Cr(VI) ion adsorption by the increase in the water absorptivity through the formation of the intermediate grafted layer of PMAAm. The maximum adsorption ratio of 0.510 was obtained for a (PE-g-PMAAm)-g-PDMAEMA plate with GMAAm = 30 µmol/cm2 and GDMAEMA = 1.7 µmol/cm2. The maximum adsorption capacity obtained in this study was comparable to or higher than those of other adsorbents for Cr(VI) ions. The adsorption behaviour obeyed the pseudo-second order kinetic model and was well described by the Langmuir isotherm model, suggesting that the adsorption of Cr(VI) ions occurs through the electrostatic interaction between protonated dimethylamino groups and HCrO4- ions. Cr(VI) ions were successfully desorbed in such eluents as NaCl, NaCl containing NaOH, NH4Cl, NH4Cl containing NaOH, and NaOH and (PE-g-PMAAm)-g-PDMAEMA plates were repeatedly used without considerable loss in the adsorption capacity.

[A Case of Inverted LECS for GIST Near the Pylorus Ring].

Laparoscopy and endoscopy cooperative surgery(LECS)is a surgical procedure to avoid excessive resection of the gastrointestinal wall and preserve its function. For gastrointestinal stromal tumors(GIST)near the cardia and pylorus ring, the function of the cardia and pylorus can be preserved by minimum excision and hand-sewn suture closures. Here, we report a case successfully treated with inverted LECS for GIST near the pylorus ring. The patient was a 58-year-old male. Upper gastrointestinal endoscopy had revealed a 45 mm sized SMT near the pylorus ring. Biopsy by EUS-FNA indicated gastric GIST. The tumor was separated from the pylorus ring and inverted LECS was performed. The defect was closed with hand-sewn sutures, forming an L-shape. The postoperative course was good and he was discharged from hospital 10 days after surgery. It is considered that devising the direction of closure by means of the LECS procedure can preserve the pyloric function without passage obstruction or stasis, even for gastric GIST near the pylorus ring.

[Unresectable Advanced HER2-Positive Gastric Cancer Leading to a Perforation during Chemotherapy with Trastuzumab plus Paclitaxel].

The patient was a 70s female with gastric cancer. CT and PET scans revealed metastases of para-aortic lymph nodes, hepatoduodenal ligament lymph nodes, and left supraclavicular lymph nodes. She was diagnosed with T4a, N2, M1(LYM), and cStage ⅣB and was given chemotherapy with paclitaxel due to chronic kidney disease and trastuzumab treatment. We planned to perform radical gastrectomy with lymph node dissection due to the disappearance of FDG uptake except for primary gastric cancer on PET scans 5 months after chemotherapy. However, the patient developed pan-peritonitis due to gastric cancer perforation; therefore, emergency distal gastrectomy with Billroth Ⅱ reconstruction was performed. She received chemotherapy(only trastuzumab)after getting discharged. Reports about gastric cancer perforation during chemotherapy using trastuzumab are rare. We should consider the possibility of perforated gastric cancer during chemotherapy and optimal surgical procedures, including the extent of lymph node dissection in the case of Stage Ⅳ gastric cancer.

Hexavalent Cr ion adsorption and desorption behaviour of expanded poly(tetrafluoro)ethylene films grafted with 2-(dimethylamino)ethyl methacrylate.

A new polymeric adsorbent for Cr(VI) ions based on an expanded poly(tetrafluoroethylene) (ePTFE) film was prepared by the combined use of the pretreatment with oxygen plasma and photografting of 2-(dimethylamino)ethyl methacrylate (DMAEMA). The grafting of DMAEMA was characterized by XPS and FT-IR spectroscopic measurements. The adsorption behaviour of DMAEMA-grafted ePTFE (ePTFE-g-PDMAEMA) films was investigated as a function of the experimental parameters, such as the initial pH value, temperature, and grafted amount. The adsorption capacity and initial adsorption rate had the maximum values at the initial pH value of 3.0. On the other hand, the adsorption capacity became almost constant at temperatures higher than 30°C, although the adsorption rate increased over the temperature. The adsorption behaviour obeyed the pseudo-second-order kinetic model and well expressed by the Langmuir isotherm equation with higher correlation coefficients. These results indicate that the adsorption of Cr(VI) ions occurs through the electrostatic interaction between protonated dimethylamino groups on a grafted PDMAEMA chain and HCrO4- ions. Cr(VI) ions were successfully desorbed from Cr(VI)-loaded ePTFE-g-PDMAEMA films in the eluents, such as NaCl at 0.50 M, NH4Cl at 0.50M, and NaOH at 1.0 mM, and ePTFE-g-PDMAEMA films were repeatedly used for adsorption of Cr(VI) ions without appreciable loss in the adsorption capacity. It should be noted that Cr(VI) ion adsorptivity with a high initial rate was conferred to the ePTFE films. The results obtained in this study emphasize that ePTFE-g-PDMAEMA films can be applied as an adsorbent for Cr(VI) ions.

[A Case of Laparoscopic Subtotal Gastrectomy with a Very Small Remnant Stomach in an Elderly Patient with Multiple Malignant Gastric Tumors].

An 85-year-old man was referred to our hospital for anemia. Upper gastrointestinal endoscopy showed 6 malignant gastric lesions. Abdominal CT showed a primary tumor. We treated early gastric cancer at the upper stomach with endoscopic submucosal dissection(ESD)to avoid total gastrectomy. We then performed laparoscopic subtotal gastrectomy with a very small remnant stomach. In elderly patients with multiple gastric cancer, it is useful to combine ESD with laparoscopic subtotal gastrectomy with a very small remnant stomach.

[A Case of Colon Cancer with Suspected DPD Deficiency Causing Severe Adverse Effects following Adjuvant Chemotherapy with Capecitabine].

The present study reports a case of colon cancer in a 76-year-old female who underwent laparoscopic right colectomy. Pathological findings revealed pT3(SS), pN2a, cM0, and pStage Ⅲb. Hence, we administered adjuvant chemotherapy with capecitabine. On day 18, she was urgently hospitalized because of severe oral mucositis(grade 3), diarrhea(grade 3), and leukocytopenia(grade 4). Furthermore, the patient experienced DIC, which gradually improved through intensive conservative treatment. From the clinical course, we suspected that the severe adverse effects were caused due to a deficiency of DPD. We were able to save the patient through early treatment.

Nutritional assessment and surgical outcomes in very elderly patients undergoing pancreaticoduodenectomy: a retrospective study.

PURPOSE: To evaluate and compare the nutritional factors and clinical outcomes of pancreaticoduodenectomy between elderly and non-elderly patients. METHODS: This retrospective study evaluated 122 consecutive patients who underwent pancreaticoduodenectomy from April 2008 to April 2020. Preoperative and postoperative nutritional factors (prognostic nutritional index), complication rates, and survival rates were compared between the elderly (≥ 80 years) and non-elderly (< 80 years) patient groups. Changes in nutrition markers were evaluated before surgery to 1 year after surgery. RESULTS: A total of 20 elderly patients (16.4%) and 102 non-elderly patients (83.6%) underwent pancreaticoduodenectomy. Elderly patients had a significantly lower preoperative prognostic nutritional index than did non-elderly patients. At 3 months postoperatively, elderly patients had a lower albumin level and prognostic nutritional index. The median length of hospital stay was significantly longer (39.9 vs. 27 days, P = 0.004), the rate of death due to other diseases was higher, and the overall survival rate was significantly lower (1-/3-/5 year overall survival rates: 78.1%/26.7%/13.3% vs. 87.1%/54.4%/46.7%; log-rank test, P = 0.003) in the elderly group than in the non-elderly group. CONCLUSIONS: The results suggest that careful patient selection and optimal perioperative care are necessary to determine whether pancreaticoduodenectomy is indicated for elderly patients.

Solitary Cardiac Metastasis of Hepatocellular Carcinoma.

Cardiac metastasis originating from hepatocellular carcinoma (HCC) is a rare condition with a poor prognosis. No therapeutic standards for cardiac metastasis originating from HCC have been established. At 19 months after a curative hepatectomy, a 64-year-old Japanese hepatitis B virus-positive male patient experienced solitary cardiac metastasis originating from HCC. The cardiac tumor was discovered in the right ventricle. The patient received three courses of radiotherapy and chemotherapy and survived > 3 years after the initial diagnosis of cardiac metastasis. His case demonstrates that radiotherapy combined with chemotherapy can be an effective treatment for cardiac metastasis.

The Late Phase/Early Phase Ratio of Pancreatic CT Values as a Novel Predictor of Pancreatic Fistula after Distal Pancreatectomy.

Post-operative pancreatic fistula (POPF) remains the most common complication after distal pancreatectomy (DP). In this retrospective study, we reviewed the data from patients who underwent DP between 2008 and 2019 in our institute to determine whether the late phase/early phase ratio (L/E ratio) by preoperative computed tomography (CT) scan in the pancreas could predict POPF occurrence after DP. We examined the relationship between preoperative or intraoperative factors and the occurrence of POPF after DP using statistical methods in 23 males and 21 females with a mean age of 73. The mean L/E ratio was significantly lower in the POPF group than the non-POPF group (p=0.035). The L/E ratio had moderate diagnostic accuracy, with a calculated optimal cutoff value of 0.77. In univariate analysis, a significant association was noted between POPF and stump thickness ≥ 16.9, body mass index ≥ 27.5, and L/E ratio ≤ 0.77. In the multivariate analysis, the L/E ratio (odds ratio, 5.96; p=0.036) was an independent risk factor for POPF. Our findings suggest that the pancreatic L/E ratio may predict the occurrence of POPF after DP. This measure may be useful in preoperative risk stratification, patient counseling, and perioperative patient management, improving clinical outcomes after DP.

Preoperative predictive factors of pancreatic fistula after pancreaticoduodenectomy: usefulness of the CONUT score.

PURPOSE: Postoperative pancreatic fistula (POPF) is the most important factor affecting morbidity and mortality after pancreaticoduodenectomy (PD). Patients with a high controlling nutritional status (CONUT) score, which is used to assess nutritional status, are expected to have high morbidity rates. This study aimed to determine the usefulness of the CONUT score. METHODS: Data from 97 consecutive cases of PD performed in the Department of Surgery of Iwakuni Clinical Center, from April 2008 to May 2018, were included. Preoperative patient data, including sex, age, and hypertension, and postoperative complication data were collected to analyze pancreatic fistula occurrence. RESULTS: Of the 97 patients, 2 9 patients (29.8%) were diagnosed with POPF ≥ B, with 26 cases (26.8%) classified as grade B and 3 (3.1%) as grade C. The mortality rate was 2.1% (2 of 97). In the univariate analysis, a significant association was observed between POPF and the following factors: body mass index (BMI) ≥ 22 kg/m2, high CONUT score, nonpancreatic carcinoma, and CT attenuation values. In multivariate analysis, BMI ≥ 22 kg/m2 (odds ratio [OR], 6.16; P < 0.001), high CONUT score (OR, 3.77; P = 0.009), nonpancreatic carcinoma (OR, 5.72; P = 0.009), and CT attenuation values (late/early ratio) in the pancreas (OR, 9.07; P = 0.006) were independent risk factors for POPF. CONCLUSION: Patients with a high CONUT score are at high risk of POPF. Further study correlating preoperative nutritional intervention with risk of POPF is necessary.

Preoperative C-Reactive Protein/Albumin Ratio as a Predictive Factor for Gallbladder Carcinoma.

BACKGROUND/AIM: The C-reactive protein (CRP) to albumin ratio (CAR) is associated with outcomes in patients with sepsis. We aimed to evaluate the significance of preoperative CAR in therapeutic outcomes after gallbladder carcinoma (GBC) resection. PATIENTS AND METHODS: Fifty-three patients who underwent surgical resection for GBC between January 2008 and September 2019 were enrolled. We retrospectively investigated the relation between preoperative CAR and overall and disease-free survival. RESULTS: The optimal cut-off CAR was 0.07. Multivariate analysis showed that i) R1 or R2 resection (p=0.033), ii) advanced tumor stage (p=0.047), iii) CAR≥0.07 (p=0.011), and iv) postoperative complications (p=0.028) were significant independent predictors of overall survival; moreover, higher carbohydrate antigen levels (p=0.036) and R1 or R2 resection (p<0.001) were significant independent predictors of disease-free survival. CONCLUSION: Preoperative CAR may be a significant independent predictor of long-term outcomes after GBC resection.

Preoperative Nutritional Assessment Using the Controlling Nutritional Status Score to Predict Pancreatic Fistula After Pancreaticoduodenectomy.

Backgound: This study aimed to determine the usefulness of the Controlling Nutritional Status (CONUT) scorescore for predicting postoperative pancreatic fistula (POPF). PATIENTS AND METHODS: Data from 108 consecutive pancreaticoduodenectomy cases performed at the Surgery Department of Iwakuni Clinical Center, from April 2008 to May 2018, were included. Preoperative patient data and postoperative complication data were collected. RESULTS: Of the 108 patients (male=65; female=43; mean age=70 years), 41 (37.9%) had indication for pancreaticoduodenectomy due to pancreatic carcinoma. Grade B or higher POPF was diagnosed in 32 patients (29.6%). In the multivariate analysis, body mass index ≥22 kg/m2 [odds ratio (OR)=5.24; p=0.005], CONUT score ≥4 (OR=3.28; p=0.042), non-pancreatic carcinoma (OR=47.17; p=0.001), and a low computed tomographic contrast attenuation value (late/early ratio) (OR=4.39; p=0.029) were independent risk factors for POPF. CONCLUSION: Patients with high CONUT score are at high risk for POPF. Preoperative nutritional intervention such as immunonutrition might help reduce the POPF risk in these patients.

Adequacy evaluation of the annual colonoscopic surveillance and individual difference of disease phenotypes in Lynch syndrome.

BACKGROUND: Regular endoscopic surveillance for Lynch syndrome is reported to reduce colorectal cancer (CRC)-related mortality. However, the appropriate surveillance intervals are still unclear. We evaluated the adequacy of annual colonoscopy and investigated the differences in tumor occurrence rates between individual patients. METHODS: In total, 25 patients with Lynch syndrome who underwent colonoscopic surveillance between 2007 and 2016 at the Iwakuni Clinical Center were included. We retrospectively investigated the surveillance frequency and the clinical features associated with tumor development. RESULTS: Colonoscopic surveillance was performed every 397 days on average. A total of 101 tumors, including 8 intramucosal carcinomas and 15 carcinomas, were observed within the study period. Annual colonoscopy detected six malignancies, including a carcinoma requiring surgery. Tumor incidence was associated with tumor existence in the initial colonoscopies (P = 0.018). Patients with a tumor occurrence rate of 0.4 tumors per year during our observation period were significantly more likely to have malignancies detected during regular surveillance than patients who had a lower occurrence rate (P < 0.001). Malignancy occurrence rate was strongly associated with tumor occurrence rate (P < 0.001, R2 = 0.44). CONCLUSIONS: Annual colonoscopic surveillance for Lynch syndrome patients was effective in reducing the risk of CRC progression, but was insufficient to completely avoid surgery. Because the tumor occurrence rate differed substantially between individuals, more intensive surveillance was required for high-risk patients.

[A Case of Laparoscopic Distal Gastrectomy for Gastric Cancer with Common Hepatic Artery Anomaly].

A 67-year-old woman with upper abdominal pain was referred to our hospital. Upper gastrointestinal endoscopy revealed a type 3 gastric cancer at the greater curvature of the angular notch. Abdominal CT helped detect the primary tumor. Multi-detector-row computed tomography(MDCT)and 3D-CT angiography revealed a vascular anomaly in which the left gastric and splenic arteries formed the common trunk. The common hepatic and superior mesenteric arteries formed the common trunk. We performed a laparoscopic distal gastrectomy with D2 lymph node dissection. During suprapancreatic lymph node dissection, the surface of the portal vein was difficult to expose toward the left side because the portal vein joined the splenic and superior mesenteric veins on the caudal side. Therefore, the No. 8a lymph nodes were dissected along the anterior hepatic plexus. In cases of common hepatic artery anomaly, identifying the anterior hepatic plexus is useful for the dissection of the suprapancreatic lymph nodes.

[A Case of Surgery for Transversal Colon Cancer with Intestinal Malrotation -Visualizing Method of Blood Flow in the Fluorescence Navigation Period].

BACKGROUND: Anastomotic blood flow evaluation using the fluorescence method with indocyanine green(ICG)is expected to decrease the risk of anastomotic leakage in colorectal cancer surgery. The fluorescence method is considered to be also useful for assessing arterial divergence patterns in patients with special anatomical features. We report a case of transverse colon cancer with intestinal malrotation treated with laparoscopic surgery using the ICG fluorescence method. CASE: A 62- year-old woman who was diagnosed as having transverse colon cancer with intestinal malrotation underwent a laparoscopic transverse colon resection with D3 lymph node dissection. We identified the ileocolic artery and middle colic artery (MCA)after the ICG injection and the severed MCA during lymphadenectomy. We made a final diagnosis of pT2N0M0, pStage Ⅰ. CONCLUSION: The fluorescence method was useful for assessing the arterial divergence pattern in a patient with a special anatomical feature. However, the ICG fluorescence method had some problems, including visualizing blood flow for only a short time and poorly transmitting the dye through thick fat.

Mechanistic Study on Allylic Arylation in Water with Linear Polystyrene-Stabilized Pd and PdO Nanoparticles.

The catalytic cycle of allylic arylation in water catalyzed by linear polystyrene-stabilized Pd or PdO nanoparticles (PS-PdNPs or PS-PdONPs) was investigated. Stoichiometric stepwise reactions indicated that the reaction did not proceed stepwise on the surface of the catalyst. In the case of the reaction with PS-PdNPs, the leached Pd species is the catalytically active species and the reaction takes place through a similar reaction pathway accepted in the case of a complex catalyst. In contrast, allylic arylation using PS-PdONPs as a catalyst occurs via a Pd(II) catalytic cycle.

Safety of Surgical Treatment for Elderly Patients with Gallbladder Carcinoma.

Gallbladder carcinoma (GBC) is a common malignancy with a poor prognosis. With the average life expectancy increasing globally, the incidence of GBC is predicted to increase as well. We investigated the safety and feasibility of surgical treatment for elderly patients with GBC. We retrospectively compared clinical pathological data and treatment outcomes in 45 consecutive GBC patients (23 patients ≥ 75 years [elderly group] and 22 patients < 75 years [younger group]) who underwent curative resection at the Iwakuni Center from January 2008 to December 2017. The proportion of preoperative comorbidities and anticoagulant use was significantly higher in the elderly group. The American Society of Anesthesiologists score was higher in the elderly versus the younger group, and the elderly group had significantly shorter operation times. Reduced activities of daily living was more common in the elderly versus younger group. The percentage of radical resection and overall 3-year survival (66.6% younger vs. 64.4% elderly) were similar between the groups. Controlling Nutritional Status (CONUT) score ≥ 3 and R0 resection were identified as prognostic factors for overall survival rate among all patients. After careful patient selection.

Pancreatic Ductal Adenocarcinoma in Remnant Pancreas after Pancreaticoduodenectomy for Acinar Cell Carcinoma: A Case Report.

We report a case of a pancreatic ductal adenocarcinoma (PDAC) in the remnant pancreas of a 78-year-old man after pancreaticoduodenectomy for acinar cell carcinoma, a relatively rare pancreatic neoplasm. After diagnosis of pancreatic carcinoma, subtotal stomach-preserving pancreaticoduodenectomy was performed. The pathological diagnosis was acinar cell carcinoma of the pancreas (disease stage IA, pT1, pN0, M0), without regional lymph node invasion. Cancer antigen 19-9 levels gradually increased during the 22 months after surgery, and computed tomography showed two solid tumors, 1.1 and 2.1 cm in diameter, at the site of the remnant pancreas. Endoscopic ultrasound fine-needle aspiration revealed pancreatic ductal adenocarcinoma. The tumor cells were not immunoreactive for trypsin. Both tumors were diagnosed as PDAC of the remnant pancreas. The patient declined curative resection, and chemoradiotherapy was started as alternative treatment. The patient died 28 months after surgery. Because this is an extremely rare case, additional cases and studies are needed in order to clarify its pathogenesis.

Removal of Linear and Branched Alkylphenols with the Combined Use of Polyphenol Oxidase and Chitosan.

Removal of linear and branched alkylphenols with different alkyl chain lengths or different branchings (normal, secondary, and tertiary), some of which are suspected as endocrine disrupting chemicals, from an aqueous medium were investigated through quinone oxidation by polyphenol oxidase (PPO) and subsequent quinone adsorption on chitosan beads or powders at pH 7.0 and 40 °C. PPO-catalyzed quinone oxidation increased with an increase in alkyl chain length of the alkylphenols used. Although a higher PPO dose was required for quinone oxidation of branched alkylphenols, they were completely or mostly removed by quinone adsorption on chitosan beads or powders. The apparent activity of PPO increased by a decrease in quinone concentration. On the other hand, in the homogeneous systems with solutions of chitosan and PPO at pH 6.0, longer reaction times were required to generate insoluble aggregates, and a small amount of quinone derivatives were left in the solution even under optimum conditions. These results support that the two-step reaction, that is, PPO-catalyzed quinone oxidation and subsequent quinone adsorption on chitosan beads or powders, in the heterogeneous system is a good procedure for removing linear and branched alkylphenols from aqueous medium.

Two-step grafting of 2-hydroxyethyl methacrylate (HEMA) and 2-(dimethylamino)ethyl methacrylate (DMAEMA) onto a polyethylene plate for enhancement of Cr(VI) ion adsorption.

Polyethylene (PE) plates grafted with a neutral monomer, 2-hydroxyethyl methacrylate (HEMA), and a cationic monomer, 2-(dimethylamino)ethyl methacrylate (DMAEMA), (PE-g-PHEMA)-g-PDMAEMA plates were prepared by the two-step photografting. The Cr(VI) ion adsorption behavior of the (PE-g-PHEMA)-g-PDMAEMA plates was investigated as a function of the amounts of grafted HEMA, amount of grafted DMAEMA, initial pH value, and temperature. The adsorption capacity of the DMAEMA-grafted PE (PE-g-PDMAEMA) and (PE-g-PHEMA)-g-PDMAEMA plates had the maximum value at the initial pH value of 3.0, independent of the temperature. The adsorption capacity of (PE-g-PHEMA)-g-PDMAEMA plates increased with the amount of grafted HEMA (GHEMA) in the first-step grafting. The increase in the water absorptivity of the grafted layers and thereby the increase in the degree of protonation of dimethylamino groups on grafted PDMAEMA chains were found to lead to the increase in the adsorption capacity. This adsorption capacity was higher than or comparable to those of other polymeric adsorbents for Cr(VI) ions. The Cr(VI) ion adsorption behavior on both PE-g-DMAEMA and (PE-g-PHEMA)-g-PDMAEMA plates obeyed the mechanism of the pseudo-second-order kinetic model and was well expressed by Langmuir isotherm. The high values of the Langmuir constant suggest that the adsorption of Cr(VI) ions occurs through an electrostatic interaction between protonated dimethylamino groups on grafted PDMAEMA chains and HCrO4- ions. Cr(VI) ions were successfully desorbed from PE-g-PDMAEMA and (PE-g-PHEMA)-g-PDMAEMA plates in eluents such as NaCl, NaCl containing NaOH, NH4Cl, NH4Cl containing NaOH, and NaOH.