Therapeutic strategies for protecting the brain against ischemic injury aim to salvage the ischemic penumbra or to expand the therapeutic time window, or both. We have investigated the protective effects of several agents using a rat model of transient focal cerebral ischemia. Our experimental studies have identified the following agents with attractive protective mechanisms against brain ischemia: the free-radical scavenger edaravone (MCI-186), the immunosuppressant tacrolimus (FK506), bone marrow stromal cells (BMSCs) /bone marrow mononuclear cells (BMMCs), the ω3 polyunsaturated fatty acid eicosapentaenoic acid (EPA), and the hydroxymethyl glutaryl coenzyme A reductase inhibitor atorvastatin. The free-radical scavenger MCI-186 has a Bax/Bcl-2-dependent antiapoptotic mechanism in a rat model of transient focal cerebral ischemia. The therapeutic time window for FK506 in rat transient focal ischemia is from 60 to 120 minutes after ischemia induction, and mild hypothermia (35°C) expands the therapeutic time window up to 120 minutes after ischemia induction. Intravenous transplantation of BMSCs 120 minutes after ischemia induction, which is out of the therapeutic time window for FK506 alone, is neuroprotective when performed in conjunction with FK506 injection. Intra-arterial transplantation of BMMCs is more protective against transient focal cerebral ischemia than is intravenous transplantation of BMMCs. Repeated intravenous transplantation of BMMCs achieves further neuroprotection against ischemic brain injury. Pretreatment with ethyl-EPA inhibits endothelial Rho-kinase activation and reduces tissue oxidative stress following transient ischemia, resulting in strong neuroprotection. The long-term protective effects of atorvastatin against brain ischemia require continuous oral administration after ischemia/reperfusion. All of the agents used in our experimental studies are established therapies for ischemic stroke or other disorders. Further investigations are needed before such experimental brain protection strategies can be applied clinically.
Cancer cachexia, characterized by anorexia and loss of muscle mass, has a negative effect on patient quality of life. In addition, the medical management of cancer cachexia remains difficult because of the multifactorial pathophysiology involved. Various drugs and other treatments have been tested with limited success, but a recent clinical trial suggests that multitargeted treatments would be effective. In this article, we describe such a combination therapy for cancer cachexia.
Surgical treatment is more difficult for remnant gastric cancer than for primary gastric cancer because of adhesions to adjacent organs. Severe adhesions between the remnant stomach and the left lobe of the liver make difficult to remove the remnant stomach. Laparoscopic gastrectomy has gradually gained acceptance for the treatment of primary gastric cancer because of the potential benefits of being less invasive and having a shorter recovery time but has generally been considered contraindicated in patients who have undergone open upper abdominal surgery. However, few reports have described laparoscopy-assisted total gastrectomy after open or laparoscopic gastrectomy. The benefits and feasibility of laparoscopic surgery for remnant gastric cancer remain unclear. We describe in detail the procedure of laparoscopy-assisted total gastrectomy for remnant gastric cancer and evaluate its safety and feasibility.
The incidence of aspiration pneumonia related to gastroesophageal reflux disease in Japan is increasing as the population ages. Such pneumonia tends to recur and to be refractory to conservative treatment because gastroesophageal reflux persists. Laparoscopic surgery provides a reliable treatment for gastroesophageal reflux but is not commonly performed in Japan, especially for patients with poor performance status. We report our experience treating patients with aspiration pneumonia caused by gastroesophageal reflux. The patients had severe pneumonia that recurred after medical management and resulted in prolonged hospitalization. These patients were referred for surgical treatment and underwent laparoscopic surgery to treat the underlying gastroesophageal reflux. In patients with poor performance status, we also performed laparoscopic gastrostomy for two reasons: 1) to provide a drainage route from the stomach if antireflux effect of surgery was inadequate and 2) to provide a feeding route if performance status did not improve and oral intake was impossible. The outcomes were excellent, the patients were discharged soon after surgery, and aspiration pneumonia has not recurred to date. In conclusion, laparoscopic antireflux surgery is a useful and promising treatment for patients with recurrent aspiration pneumonia. It may shorten hospital stays and thus reduce medical costs.
This paper explains logistic regression analysis, which is a commonly used technique in medical statistics. In particular, the basic ideas and methods of interval estimation and hypothesis testing with the software package SPSS are explained.