Some studies have reported that adrenomedullin （AM） is involved in diabetes mellitus （DM） associated with pancreatic cancer. Therefore, in this study we investigated the relationship between diabetes and AM expression in patients with pancreatic cancer. We examined 48 biopsies and 26 surgical resections from 74 patients with histologically diagnosed pancreatic cancer. Patients were classified into either DM or non-DM groups. The immunohistochemical expression of AM and various clinicopathological factors were compared between the two groups. Among the biopsy cases, 21 were classified as DM and 27 as non-DM. AM expression in pancreatic cancer cells was significantly lower in the DM group （p＝0.03）. No significant differences were noted in age, body mass index, tumor diameter or location, serum CA19-9, amylase, or C-reactive protein levels, pancreatic ductal dilatation, portal vein invasion, clinical stage, or histological differentiation between the DM and non-DM groups. The proportion of men was significantly lower in the DM group （p＝0.04）, as was the frequency of liver metastasis at diagnosis （p＝0.03）. Among the resection cases, 13 were classified as DM and 13 as non-DM. There were no significant differences in AM expression in pancreatic cancer cells between the two groups. However, marked AM expression was observed in the inflammatory cells and fibroblasts of the tumor stroma in all cases. In addition, the inflammatory response in the tumor stroma tended to be stronger in the DM group. Although the present study failed to find a positive correlation between diabetes and AM expression in pancreatic cancer cells, the results indicate that AM expression in stromal cells may be more closely related to the development of DM in pancreatic cancer patients.

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In recent years, fetal endoscopic tracheal occlusion （FETO） using a balloon has been clinically employed for promoting prenatal lung growth to ameliorate postnatal respiratory failure caused by severe in utero lung hypoplasia. After a successful FETO, in some limited fetal centers, planned or emergency balloon removal using another fetoscopy is performed to release the tracheal occlusion immediately before delivery. To overcome this additional fetoscopy, we previously reported an innovative simple procedure to remove the occluding balloon by bursting it with a pre-planned sequence of high intensity focused ultrasound （HIFU） irradiation. In that previous study, which used rabbits euthanized and submerged in degassed water, we inflated the balloon by injecting a mixture of perfluorocarbon and ultrasound contrast medium through a fetoscopically-guided catheter. The rate of successful balloon burst and deflation using HIFU irradiation was high enough （100％）, but the mode and timing of tracheal reopening （i.e., sudden burst or slow shrinkage of the balloon） was rather varied and collateral damage to the dermal/tracheal tissue was identified in 72.7％ of the experimental animals. Accordingly, to standardize the HIFU irradiation sequence and to achieve a reliable and secure balloon burst, we conducted another series of animal experiments in which the mixture of perfluorocarbon was replaced with “limonene emulsion” （D-limonene micelle emulsified in physiological saline） as the balloon injection fluid. In all 6 animals, we succeeded in reopening the airway by achieving an instantaneous and timely balloon burst without definite skin/tracheal damage. We conclude that HIFU irradiation together with injecting the balloon with “limonene emulsion” is an improved method for safe tracheal release from a balloon occlusion.

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Triple-negative breast cancer （TNBC） accounts for 10-15％ of all breast cancer cases and shows a poor prognosis with 30％ distant metastasis. With few specific target molecules and ineffective hormonal and anti-HER2 treatment, an alternative therapeutic method for TNBC is urgently required. Recently, a non-taxane inhibitor of microtubule dynamics called eribulin was developed for breast cancer therapy. Eribulin induces irreversible mitotic mass formation in cancer cells during the G2-M phase, initiating apoptosis; however, the mechanism underlying this eribulin activity remains unclear. We reported previously that exposing non-basal-like （NBL） TNBC cells to eribulin increases miR-195 expression, which in turn decreases the expression of targeted Wnt3a. The present study sought to further clarify the mechanism of this antitumor effect by exploring how eribulin affects Wnt/β - catenin signaling based on miRNA expression changes in TNBC. In an NBL type of human breast cancer cell line （MDA-MB-231 cells）, we compared the expression levels of Wnt/β catenin signaling pathway proteins in cells exposed to an miR-195 mimic （cells transfected with miR-195 and in which Wnt3a expression was suppressed） and in cells exposed to eribulin. Expression levels of Wnt3a, β -catenin, and GSK-3β were measured by ELISA and observed by fluorescence immunostaining. Wnt3a and β -catenin expression was significantly lower and GSK-3β expression was significantly higher in the cells exposed to eribulin and transfected with miR-195 mimic than in the untreated controls, suggesting that eribulin inactivates the Wnt/β -catenin signaling pathway. Therefore, a novel antitumor mechanism of eribulin was determined, whereby eribulin induces high expression of miR-195 to inactivate the Wnt/β -catenin signaling pathway in NBL-type TNBC.

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Single-port laparoscopic surgery（SPLS）has attracted attention in the field of minimally invasive surgery; however, the associated technical difficulty has delayed its adoption by all surgeons. Reduced-port laparoscopic surgery might be easier to perform than SPLS, and in this prospective study, we compared surgeon stress and workload between reduced-port laparoscopic cholecystectomy（RPLC）and conventional laparoscopic cholecystectomy（CLC）. Twenty consecutive patients were assigned to undergo either RPLC or CLC between July 2016 and April 2017. Two surgeons performed the operations. The differences in surgeon workload and stress between RPLC and CLC were evaluated. Patient factors and operative outcomes were not significantly different between RPLC and CLC. In the surgeon-reported Surgery Task Load Index, the task demand subscale was significantly higher for RPLC than for CLC（P＝0.005）, although the salivary amylase levels were not significantly different between RPLC and CLC. RPLC was similar to CLC with respect to surgeon stress. Considering workload, the task demand was higher in CLC than in RPLC, which therefore might be an acceptable alternative to CLC for treating benign gallbladder disease.

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Raman spectroscopy has become a remarkable tool for real-time detection and diagnosis of various cancers. We investigated whether Raman spectroscopy can be used to diagnose colorectal cancer. Samples of cancerous and non-cancerous tissues were obtained from 12 patients undergoing surgery for such cancer. A handheld Raman spectrometer employing an excitation wavelength of 1,064nm was used at 94 points: 48 points on cancerous tissues and 46 points on normal tissues. Using principal component analysis （PCA）, we selected 12 PCs from the Raman spectra obtained at each of the 94 observed points. We then used linear discriminant analysis （LDA） to distinguish cancer from normal tissues and early cancer from advanced cancer, and we calculated sensitivity, specificity, and accuracy of the Raman spectroscopy for such diagnoses. We immediately confirmed that there was no local temperature rise, color change, or damage at the irradiated points, and we found that Raman spectroscopy was able to distinguish cancer from normal tissues with a sensitivity of 87.5％, specificity of 82.6％, and accuracy of 85.1％. In addition, Raman spectroscopy distinguished early cancer from advanced cancer with a sensitivity of 85.7％, specificity of 83.3％, and accuracy of 85.4％. Thus, near-infrared Raman spectroscopy shows potential as an objective, rapid, non-invasive diagnostic modality for colorectal cancer.

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In Japan, amebiasis is typically found in men who have sex with men and in individuals with recent travel to endemic areas. We experienced a patient with fulminant necrotizing amebic colitis and enterocolitis who presented with a severe disorder of the liver and renal function. The patient was a 71-year-old man who had lived in Yokohama City, Japan for 30 years. His stool sample showed no amebic dysentery protozoa and cultured negatively for human immunodeficiency virus. Despite being treated with meropenem, pyrexia of 39-40°C continued for 4 days. On hospital day 8, a colonic abscess and perforation of the transverse colon were detected by computed tomography（CT）. His fever did not improve, suggesting progression of infectious disease. Subsequent emergency laparotomy revealed a perforation in the middle of the transverse colon. Peritoneal lavage and right hemicolectomy were performed; however, a CT scan on hospital day 16 （postoperative day 8） showed re-perforation of the colon and an abscess around the site of anastomosis, prompting emergency intestinal and left hemicolectomy resection. Amebae observed pathologically during the second emergency operation led to a diagnosis of amebic colitis. Endotoxin adsorption therapy was performed, and metronidazole was administered. Despite prompt diagnosis and treatments, the patient’s general conditions became fulminant, and multiple organ failure developed. On hospital day 18 （postoperative day 10）, his C-reactive protein level was 20mg/dl. He was clinically diagnosed as having sepsis and multiple organ failure. The patient died on hospital day 23. Acute colitis is commonly encountered in daily practice, but it is difficult to differentiate between amebic and non-amebic colitis preoperatively and thus, the possibility of amebic colitis should be considered in such clinical presentations.

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Depressed patients often feel anxiety and have suicidal ideations. Such feelings are closely related to the concept of time perspective. The aims of the present study were to clarify time perspective in depressed patients using the Time Perspective Test （TPT） and to verify the effectiveness of the TPT as an assessment tool. In the present study, depressed patients （n＝15） and healthy volunteers （n＝40） were administered the TPT, and their responses regarding time perspective were compared. Depressed patients had negative present and past time perspectives, and no future time perspective. In addition to poor responses to the TPT, the test revealed dichotomous thinking and poor interpersonal relationships in depressed patients. These findings suggest that the TPT is useful for gaining an understanding of the condition of depressed patients, and is an effective assessment tool that can be used by physicians, nurses, and other health professionals to obtain important information about depressed patients.

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Various methods, devices, and techniques have been developed to improve safety during laparoscopic hepatectomy procedures. Among these, the Pringle maneuver （PM） is widely used to minimize blood loss during liver transections; however, the risk of ischemic injury associated with this technique is increased by poor hepatic reserve and regeneration dysfunction secondary to liver cirrhosis. This retrospective study evaluated the short-term outcomes and feasibility of precoagulation for endoscopic hepatectomy without PM in patients with liver cirrhosis. Eleven patients with liver cirrhosis who also underwent endoscopic hepatectomy for hepatocellular carcinoma were recruited to undergo either microwave tissue coagulation or radiofrequency ablation for precoagulation before liver transection. A wedge resection without the PM was performed in all patients, with seven patients selected for bipolar radiofrequency ablation and four patients for microwave coagulation therapy. The procedures included video-assisted thoracoscopic hepatectomy in two patients and laparoscopic hepatectomy in nine patients. One patient who underwent radiofrequency ablation developed postoperative bleeding （Clavien-Dindo grade Ⅲ）. In conclusion, precoagulation can help to minimize intraoperative blood loss without the PM, contributing to effective resection of liver tumors. We propose that precoagulation could serve as a standard technique for endoscopic hepatectomy in patients with cirrhosis.

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