Increased hepassocin secretion in hyperglycemic crisis might offset the deleterious effects of hyperglycemia on hepatocytes.
Objectives. To investigate the perioperative and oncological outcomes of hand-assisted laparoscopic nephroureterectomy (HANU) and robotic-assisted nephroureterectomy (RANU). Methods. Patients who underwent RANU were matched by sex, age (±5 years), and tumor location to those who underwent HANU; 18 matched pairs were included. Results. Each group consisted of five men and 13 women. The mean age was 70.4 years in RANU group and 69.6 years in HANU group (p = 0.646). Each group contained 10 patients with tumor location in the renal pelvis, five in the ureter, and three in both sites. The median follow-up time was 6.1 months for the RANU group and 47.8 months for the HANU group. The demographic and pathological data did not differ significantly. The RANU group had significantly less blood loss (p < 0.001), resumed oral intake earlier (p = 0.043), and had shorter hospital stays (p = 0.014) but higher pain scores associated with their wounds (p = 0.043). The oncological outcomes were comparable with those of the HANU group. Conclusions. Our results show that the RANU and HANU groups have comparable operative, early postoperative, and functional outcomes. A longer follow-up period would be needed for final comparison of oncological outcome.
Background The practice of salvaging recurrent rectal cancer has evolved. Among patients with locally-recurrent disease, we aimed to define their evolving salvage potential over time, and to identify durable determinants of long-term success. Methods In consecutive patients undergoing curative-intent multimodality salvage between 1988–2012, predictors of long-term survival were defined by Cox regression analysis and compared over time. Re-recurrence and subsequent treatments were evaluated. Results After multi-disciplinary evaluation of 229 patients, curative-intent salvage therapy included preoperative chemotherapy and/or radiation (74%, with 41% undergoing repeat pelvic irradiation), surgical salvage resection with/without intraoperative radiation (83 patients, 36%), followed by postoperative adjuvant chemotherapy (87, 38%). Curative-intent resection involved multi-visceral resection in 47% and bone resection in 30%, leading to a R0 resection rate of 81%. After a median follow-up of 56 months, the 5-year overall survival was 49.8% in 2005–2012, markedly increased from 31.5% in 1988–1997 (p=0.044). Long-term success was associated with R0 resection (p = 0.017) and lack of secondary failure (p=0.003). 125 (55%) patients had re-recurrence at 19 months (median). Repeat operative rescue was feasible in 44% of the patients with local-only and 20% of the patients with distant re-recurrence, and resulted in a median survival of 20 months after re-recurrence. Conclusions The long-term salvage potential for recurrent rectal cancer has significantly improved with time, when an individualized treatment algorithm of multimodality treatments and surgical salvage is considered. Durable predictors of long-term success were achieving an R0 resection at salvage operation, avoidance of secondary failure, and feasibility of repeat rescue after re-recurrence.
Metastatic castration-resistant prostate cancer (mCRPC) is a malignant and lethal disease caused by relapse after androgen-deprivation (ADT) therapy. Since enzalutamide is innovated and approved by US FDA as a new treatment option for mCRPC patients, drug resistance for enzalutamide is a critical issue during clinical usage. Although several underlying mechanisms causing enzalutamide resistance were previously identified, most of them revealed that drug resistant cells are still highly addicted to androgen and AR functions. Due to the numerous physical functions of AR in men, innovated AR-independent therapy might alleviate enzalutamide resistance and prevent production of adverse side effects. Here, we have identified that yes-associated protein 1 (YAP1) is overexpressed in enzalutamide-resistant (EnzaR) cells. Furthermore, enzalutamide-induced YAP1 expression is mediated through the function of chicken ovalbumin upstream promoter transcription factor 2 (COUP-TFII) at the transcriptional and the post-transcriptional levels. Functional analyses reveal that YAP1 positively regulates numerous genes related to cancer stemness and lipid metabolism and interacts with COUP-TFII to form a transcriptional complex. More importantly, YAP1 inhibitor attenuates the growth and cancer stemness of EnzaR cells in vitro and in vivo. Finally, YAP1, COUP-TFII, and miR-21 are detected in the extracellular vesicles (EVs) isolated from EnzaR cells and sera of patients. In addition, treatment with EnzaR-EVs induces the abilities of cancer stemness, lipid metabolism and enzalutamide resistance in its parental cells. Taken together, these results suggest that YAP1 might be a crucial factor involved in the development of enzalutamide resistance and can be an alternative therapeutic target in prostate cancer.
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