PURPOSE: Distant metastasis can occur early after neoadjuvant chemoradiotherapy (CRT) in patients with rectal cancer. This study was conducted to evaluate the clinical characteristics of patients who developed early systemic failure. METHODS: The patients who underwent neoadjuvant CRT for a rectal adenocarcinoma between June 2007 and July 2015 were included in this study. Patients who developed distant metastasis within 6 months after CRT were identified. We compared short- and long-term clinicopathologic outcomes of patients in the early failure (EF) group with those of patients in the control group. RESULTS: Of 107 patients who underwent neoadjuvant CRT for rectal cancer, 7 developed early systemic failure. The lung was the most common metastatic site. In the EF group, preoperative carcinoembryonic antigen was higher (5 mg/mL vs. 2 mg/mL, P = 0.010), and capecitabine as a sensitizer of CRT was used more frequently (28.6% vs. 3%, P = 0.002). Of the 7 patients in the EF group, only 4 underwent a primary tumor resection (57.1%), in contrast to the 100% resection rate in the control group (P < 0.001). In terms of pathologic outcomes, ypN and TNM stages were more advanced in the EF group (P < 0.001 and P = 0.047, respectively), and numbers of positive and retrieved lymph nodes were much higher (P < 0.001 and P = 0.027, respectively). CONCLUSION: Although early distant metastasis after CRT for rectal cancer is very rare, patients who developed early metastasis showed a poor nodal response with a low primary tumor resection rate and poor oncologic outcomes.
Adenocarcinoma ; Capecitabine ; Carcinoembryonic Antigen ; Chemoradiotherapy ; Humans ; Lung ; Lymph Nodes ; Neoadjuvant Therapy ; Neoplasm Metastasis ; Rectal Neoplasms

OBJECTIVE: This study evaluated the effects of temporary clipping on an infarction after middle cerebral artery aneurysmal surgery. METHODS: Three hundreds and seventeen patients with a middle cerebral artery aneurysm were treated surgically at our department. Among them, the patients who had an intracerebral hematoma or a cerebral infarction prior to surgery or poor clinical mental state (Hunt and Hess grade V) on admission were excluded from the analysis. Two hundreds and twenty nine patients were selected in this study. An acute cerebral infarction, which had no any evidence of retraction injury or vasospasm and occurred on the same side of the surgical site within 3 days after the operation, was regarded as the cerebral infarction as a result of the temporary clipping. RESULTS: Twenty out of 229 patients (8.7%) developed a new acute cerebral infarction after surgery. The causes of the infarction were as follows: 13 patients related to the temporary clipping, 5 patients to the vasospasm and 2 patients to the brain retraction injury. The incidence of an acute cerebral infarction according to the frequency of temporary clippings was 5.5% (3 of 55 patients) of those who underwent a single temporary clipping, 6.7% (4 of 60 patients) of those who underwent two or three temporary clipping and 20.7% (6 of 29 patients) of those who underwent more than 4 temporary clippings. The incidence of an acute cerebral infarction was significantly higher when the temporary clip had been applied more than 4 times (P<0.021). However, the clipping time didn't show statistically significance. CONCLUSION: The incidence of acute cerebral infarction after a surgery for a middle cerebral artery aneurysm was related to the frequency of temporary clippings during surgery. It was significantly higher in the cases where more than 4 temporary clipping had been applied.
Aneurysm ; Brain ; Cerebral Infarction* ; Hematoma ; Humans ; Incidence ; Infarction ; Intracranial Aneurysm* ; Middle Cerebral Artery*

Nonalcoholic steatohepatitis (NASH) is characterized by hepatocyte injury and inflammatory cell infiltration, which has been linked to peripheral insulin resistance and increased levels of triglycerides in the liver. The purposes of this study were to establish a mouse model of NASH by feeding mice a 60% high-fat diet (HFD) and to demonstrate the anti-fibrotic effects of oleuropein, which has been shown to have anti-oxidant and anti-inflammatory properties, in this HFD-induced mouse model of NASH. C57BL/6 mice were divided into three groups: a regular diet group (Chow), a HFD group and an oleuropein-supplemented HFD group (OSD), which was fed a 0.05% OSD for 6 months. The effects of oleuropein in this model were evaluated using biochemical, histological and molecular markers. The expression levels of alpha-smooth muscle actin (alpha-SMA)and collagen type I in the HFD and OSD groups were evaluated using real-time PCR and western blotting. The body weight, biochemical marker levels, nonalcoholic fatty liver disease activity score, homeostasis model of assessment-insulin resistance (HOMA-IR) and leptin levels observed in the HFD group at 9 and 12 months were higher than those observed in the Chow group. The HOMA-IR and leptin levels in the OSD group were decreased compared with the HFD group. In addition, alpha-SMA and collagen type I expression were decreased by oleuropein treatment. We established a NASH model induced by HFD and demonstrated that this model exhibits the histopathological features of NASH progressing to fibrosis. Our results suggest that oleuropein may be pharmacologically useful in preventing the progression of steatohepatitis and fibrosis and may be a promising agent for the treatment of NASH in humans.
Actins/genetics/metabolism ; Animals ; Antihypertensive Agents/*therapeutic use ; Collagen Type I/genetics/metabolism ; Diet, High-Fat/*adverse effects ; Fatty Liver/*drug therapy/etiology/metabolism ; Fibrosis/etiology/metabolism/prevention & control ; Iridoids/*therapeutic use ; Leptin/genetics/metabolism ; Liver/metabolism/pathology ; Mice ; Mice, Inbred C57BL