This article reports the guidelines for gastric cancer staging and treatment developed by the GIRCG, and contains comprehensive indications for clinical management, including radiological, endoscopic, surgical, pathological, and oncological paths.

OBJECTIVE -Our aim was to evaluate the long-term effects of transplanted islets on diabetic macro-/microangiopathy in type 1 diabetic kidney-transplanted patients.RESEARCH DESIGN AND METHODS -A total of 34 type 1 diabetic kidneytransplanted patients underwent islet transplantation and were divided into two groups: successful islet-kidney transplantation (SI-K; 21 patients, fasting C-peptide serum concentration Ͼ0.5 ng/ml for Ͼ1 year) and unsuccessful islet-kidney transplantation (UI-K; 13 patients, fasting C-peptide serum concentration Ͻ0.5 ng/ml). Patients cumulative survival, cardiovascular death rate, and atherosclerosis progression were compared in the two groups. Skin biopsies, endothelial dependent dilation (EDD), nitric oxide (NO) levels, and atherothrombotic risk factors [von Willebrand factor (vWF) and D-dimer fragment (DDF)] were studied cross-sectionally.RESULTS -The SI-K group showed a significant better patient survival rate (SI-K 100, 100, and 90% vs. UI-K 84, 74, and 51% at 1, 4, and 7 years, respectively, P ϭ 0.04), lower cardiovascular death rate (SI-K 1/21 vs. UI-K 4/13, 2 ϭ 3.9, P ϭ 0.04), and lower intima-media thickness progression than the UI-K group (SI-K group: ⌬1-3 years Ϫ13 Ϯ 30 m vs. UI-K group: ⌬1-3 years 245 Ϯ 20 m, P ϭ 0.03) with decreased signs of endothelial injuring at skin biopsy. Furthermore, the SI-K group showed a higher EDD than the UI-K group (EDD: SI-K 7.8 Ϯ 4.5% vs. UI-K 0.5 Ϯ 2.7%, P ϭ 0.02), higher basal NO (SI-K 42.9 Ϯ 6.5 vs. UI-K 20.2 Ϯ 6.8 mol/l, P ϭ 0.02), and lower levels of vWF (SI-K 138.6 Ϯ 15.3 vs. UI-K 180.6 Ϯ 7.0%, P ϭ 0.02) and DDF (SI-K 0.61 Ϯ 0.22 vs. UI-K 3.07 Ϯ 0.68 g/ml, P Ͻ 0.01). C-peptide-tocreatinine ratio correlated positively with EDD and NO and negatively with vWF and DDF.CONCLUSIONS -Successful islet transplantation improves survival, cardiovascular, and endothelial function in type 1 diabetic kidney-transplanted patients. Diabetes Care 26:1129 -1136, 2003I slet transplantation, particularly after kidney transplantation, is an alternative to pancreas transplantation to restore endogenous insulin secretion (1-7). Islet transplantation is a safe procedure leading to an improvement of glycometabolic control and of protein and lipid metabolism (1,3,6 -8). The benefits of the improvement of glycometabolic control alone on macroangiopathy are unknown (9,10).Patients with type 1 diabetes are at high risk for several cardiovascular disorders, such as coronary artery disease, stroke, peripheral arterial disease, cardiomyopathy, and congestive heart failure (11). These risks are particularly high in patients with uremia and type 1 diabetes, even after kidney transplantation (12). A worsening of carotid lesion has been observed in patients undergoing kidneyalone transplantation (13). High levels of von Willebrand factors (vWF) and Ddimer fragments (DDFs), and impaired endothelial-dependent dilation (EDD) are commonly involved in development of atherosclerosis (14). In particular, endothelium modulates platelet adhesion, macrophage migration, lipid transp...

LAG with extended lymphadenectomy for gastric cancer is a feasible and safe procedure and has several advantages despite a higher rate of morbidity. Moreover, this method can achieve a radical oncologic equivalent resection and it does not have a deleterious effect on cancer-related outcome.

Cancer-initiating cells (CICs) that are responsible for tumor initiation, propagation, and resistance to standard therapies have been isolated from human solid tumors, including colorectal cancer (CRC). The aim of this study was to obtain an immunological profile of CRC-derived CICs and to identify CIC-associated target molecules for T cell immunotherapy. We have isolated cells with CIC properties along with their putative non-CIC autologous counterparts from human primary CRC tissues. These CICs have been shown to display “tumor-initiating/stemness” properties, including the expression of CIC-associated markers (e.g., CD44, CD24, ALDH-1, EpCAM, Lgr5), multipotency, and tumorigenicity following injection in immunodeficient mice. The immune profile of these cells was assessed by phenotype analysis and by in vitro stimulation of PBMCs with CICs as a source of Ags. CICs, compared with non-CIC counterparts, showed weak immunogenicity. This feature correlated with the expression of high levels of immunomodulatory molecules, such as IL-4, and with CIC-mediated inhibitory activity for anti-tumor T cell responses. CIC-associated IL-4 was found to be responsible for this negative function, which requires cell-to-cell contact with T lymphocytes and which is impaired by blocking IL-4 signaling. In addition, the CRC-associated Ag COA-1 was found to be expressed by CICs and to represent, in an autologous setting, a target molecule for anti-tumor T cells. Our study provides relevant information that may contribute to designing new immunotherapy protocols to target CICs in CRC patients.

OBJECTIVE -Diabetes, hypertension, infections, and nephrotoxicity of certain immunosuppressive drugs (i.e., calcineurin inhibitors) can reduce functional survival of the kidney graft. Our aim was to evaluate survival, hypertrophy, and vascular function of the kidney graft in end-stage renal disease (ESRD) type 1 diabetic patients after transplant. RESEARCH DESIGN AND METHODS -The study population consisted of 234 ESRD type 1 diabetic patients who underwent kidney-pancreas (KP; 166 patients), successful kidney-islet (KI-s; 24 patients), and kidney (KD; 44 patients) transplant. Kidney size, graft survival, vascular function, and microalbuminuria were evaluated prospectively yearly for 6 years. Sixty-eight protocol kidney biopsies were performed routinely between 1993 and 1998 cross-sectionally (3.2 Ϯ 0.3 years from kidney transplant).RESULTS -The KP and KI-s groups had better cumulative kidney graft survival at 6 years than did the KD group (KP: 73%; KI-s: 86%; KD: 42%, P Ͻ 0.01). The KP group but not the KI-s/KD groups showed a persistent kidney graft hypertrophy up to 6 years of follow-up. A significant increase in creatinine levels from baseline to year 6 was evident in the KD group (1.58 Ϯ 0.08 to 2.78 Ϯ 0.44 mg/dl, P Ͻ 0.05) but not in the KP/KI-s groups. The KP/KI-s groups only showed a reduction of renal resistance index from baseline to year 6 (KP at baseline: 0.74 Ϯ 0.01 to 0.68 Ϯ 0.01%, P Ͻ 0.01; KI-s at baseline: 0.72 Ϯ 0.02 to 0.69 Ϯ 0.02%, P Ͻ 0.05). At year 6, an increase from baseline in urinary albumin excretion was observed only in the KD group (31.4 Ϯ 9.0 to 82.9 Ϯ 33.6 mg/l, P Ͻ 0.05). Preliminary data suggested that graft nitric oxide (NO) expression was higher in the KP/KI-s groups than in the KD group (data not shown).CONCLUSIONS -In ESRD type 1 diabetic patients, KP and KI-s compared with KD resulted in enhanced kidney graft survival, hypertrophy, and vascular function. Diabetes Care 28:1303-1310, 2005N ephropathy is one of the most common and most serious complications in type 1 diabetes (1,2). Glomerular hyperfiltration is the first feature of renal involvement and can be observed soon after diabetes onset, accompanied by a loss of renal functional reserve (3). Microalbuminuria appears later, as do morphological changes such as thickening of the glomerular basement membrane and mesangial expansion (4).Nephrosclerosis or glomerulosclerosis of the transplanted kidney in end-stage renal disease (ESRD) type 1 diabetic kidney transplant patients may result from the interaction of diabetes, hypertension, obesity, smoking, and dyslipidemia and from nephrotoxicity of certain immunosuppressive drugs (calcineurin inhibitors but not only) (5-6), leading to a reduction in the intrarenal vascular surface area and an increase in vascular resistance (7-10).Pancreas and islet transplantation can confer insulin independence in type 1 diabetic transplant patients, thus preventing the progression to diabetic nephropathy, improving graft survival, and ameliorating diabetic macro-/microangiopathy (6,(11)(12)(1...