After laparoscopic colorectal cancer surgery, a higher VFA and female sex are independent risk factors for incisional hernia.

The caudal-related homeobox transcription factor CDX2 has a key role in intestinal development and differentiation. CDX2 heterozygous mutant mice develop colonic polyps, and loss of CDX2 expression is seen in a subset of colon carcinoma in man. Ectopic CDX2 expression in the stomach of transgenic mice promotes intestinal metaplasia, and CDX2 expression is frequently detected in intestinal metaplasia in the stomach and esophagus. We sought to define CDX2-regulated genes to enhance knowledge of CDX2 function. HT-29 colorectal cancer cells have minimal endogenous CDX2 expression, and HT-29 cells with ectopic CDX2 expression were generated. Microarray-based gene expression studies revealed that the Multidrug Resistance 1 (MDR1/P-glycoprotein/ABCB1) gene was activated by CDX2. Evidence that the MDR1 gene was a direct transcriptional target of CDX2 was obtained, including analyses with MDR1 reporter gene constructs and chromatin-immunoprecipitation assays. RNA interference-mediated inhibition of CDX2 decreased endogenous MDR1 expression. In various colorectal cancer cell lines and human tissues, endogenous MDR1 expression was well correlated to CDX2 expression. Over-expression of CDX2 in HT-29 cells revealed increased resistance to MDR1's known substrate, vincristine and paclitaxel, which was reversed by an MDR1 inhibitor, verapamil. These data indicate that CDX2 directly regulates MDR1 gene expression via binding to elements in the promoter region. Thus, CDX2 is probably important for basal expression of MDR1, regulating drug excretion and absorption in the lower gastrointestinal tract, as well as for multidrug resistance to chemotherapy reagent in CDX2-positive gastrointestinal cancers.

BackgroundOur previous retrospective study revealed the three preoperative predictors of complicated appendicitis (perforated or gangrenous appendicitis), which are body temperature ≥37.4 °C, C-reactive protein ≥4.7 mg/dl, and fluid collection surrounding the appendix on computed tomography. We reported here an additional prospective study to verify our ability to predict complicated appendicitis using the three preoperative predictors and thus facilitate better informed decisions regarding emergency surgery during night or holiday shifts.MethodsWe prospectively evaluated 116 adult patients who underwent surgery for acute appendicitis from January 2013 to October 2014. Ninety patients with one or more predictive factors of complicated appendicitis underwent immediate surgery regardless of the time of patient’s presentation. Twenty-six patients had no predictive factors and thus were suspected to have uncomplicated appendicitis. Of the 26 patients, 14 who presented to our hospital during office hours underwent immediate surgery. The other 12 patients who presented to our hospital at night or on a holiday underwent short, in-hospital delayed surgery during office hours.ResultsAll patients with no predictive factors had uncomplicated appendicitis, whereas 37 %, 81 %, and 100 % of patients with one, two, or all three factors, respectively, were diagnosed with complicated appendicitis. The emergency operation rate decreased from 83 % before to 58 % after adopting this scoring system, but no significant differences in postoperative complication rates and hospitalization periods were observed.ConclusionsThe above-mentioned preoperative factors predictive of complicated appendicitis preoperatively are useful for emergency surgical decisions and reduce the burdens on surgeons and medical staff.

Malignant peripheral nerve sheath tumors (MPNSTs) are rare soft tissue tumors that arise from a peripheral nerve or exhibit nerve sheath differentiation. Most of these tumors arise on the trunk, extremities, or head and neck regions; they are very rarely located in the abdominal cavity. The patient was a 71-year-old man who was referred to our hospital for a mass and pain in the right lower abdomen. Abdominal computed tomography revealed a large (9 × 9 cm), well-circumscribed, lobulated, heterogeneously enhanced mass in the pelvis. Exploratory laparotomy revealed a large mass in the greater omentum, and the tumor was completely excised. Histopathological analysis revealed that the tumor was composed of spindle cells with high mitotic activity. On staining the tumor, positive results were obtained for S-100 but negative results were obtained for c-kit, cluster of differentiation (CD)34, α-smooth muscle actin, and desmin. These findings strongly supported a diagnosis of MPNST primarily arising from the greater omentum. To the best of our knowledge, this is the first reported case of an MPNST arising from the greater omentum. In this report, we have described the case of a patient with an MPNST arising from the greater omentum and have discussed the clinical characteristics and management of MPNSTs.