δ-Aminolevulinic acid (ALA)-induced porphyrin accumulation is widely used in the treatment of cancer, as photodynamic therapy. To clarify the mechanisms of the tumor-preferential accumulation of protoporphyrin, we examined the effect of the expression of heme-biosynthetic and -degradative enzymes on the ALA-induced accumulation of protoporphyrin as well as photodamage. The transient expression of heme-biosynthetic enzymes in HeLa cells caused variations of the ALA-induced accumulation of protoporphyrin. When ALA-treated cells were exposed to white light, the extent of photodamage of the cells was dependent on the accumulation of protoporphyrin. The decrease of the accumulation of protoporphyrin was observed in the cells treated with inducers of heme oxygenase (HO)-1. The ALA-dependent accumulation of protoporphyrin was decreased in HeLa cells by transfection with HO-1 and HO-2 cDNA. Conversely, knockdown of HO-1/-2 with siRNAs enhanced the ALA-induced protoporphyrin accumulation and photodamage. The ALA effect was decreased with HeLa cells expressing mitoferrin-2, a mitochondrial iron transporter, whereas it was enhanced by the mitoferrin-2 siRNA transfection. These results indicated that not only the production of porphyrin intermediates but also the reuse of iron from heme and mitochondrial iron utilization control the ALA-induced accumulation of protoporphyrin in cancerous cells.
MDTM). Use of reporting templates has the potential to reduce heterogeneity and improve report quality and, ultimately, patient outcomes.We searched our surgical database to identify all consecutive surgically-managed patients with confirmed diagnosis of pancreatic/periampullary malignancy over 18 months. CT imaging contemporaneous to decision to operate was anonymised and audited against a modified National Comprehensive Cancer NetworkÒ (NCCN) reporting template. The same imaging was reviewed by two experienced GI radiologists using the same template, new reports were compared to the originals. Statistical significance was assessed with Student t-test; k-values for interobserver relatability were calculated.59 consecutive patients (37 male, 22 female), mean age 66 (36-83), were managed surgically during this period. Histology confirmed 49 adenocarcinoma (ductal 25, periampullary 8, unspecified 19), 7 NET or mixed adenocarcinoma/NET.Original reports (n=59) contained mean key features AE standard deviation of 5.05AE1.94 (range, 1-9). Template reports (incomplete data, n=13) contained 13.69AE0.63 features (range, 12-14), P< 0.005). K-values and full Results to follow.Utilising reporting template resulted in more complete and accurate disease evaluation and is likely to have improved interobserver relatability; therefore it is likely to lead to better surgical planning and improve patient outcomes.
Wepresentacaseofstrangulatedsmallbowelobstructioninan80-year-oldmanwhounderwentleft inguinalherniarepairinMarch2017usingthetransabdominalpreperitoneal(TAPP)approach.Nocomplications were reported after TAPP repair, and he was discharged after postoperative day 2. He re-turned1yearand5monthslaterwithleft-sidedlowerabdominalpain.Computedtomographyrevealed strangulatedsmallbowelobstructionthatnecessitatedemergencysurgery.Strangulatedsmallbowelobstructionwascausedbyadhesionsobservedatthesiteofperitonealsutures,andnootheradhesionswere identified.Resectionofthestrangulatedbowelsegmentandadhesiolysiswereperformed,andanadhesion barrierwasappliedtothesuturesite.Notably,adhesionsatthesiteofperitonealsuturesmayoccasionally cause small bowel obstruction. It is recommended that an adhesion barrier be applied to the site of peritonealclosure.
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