Kelly [8], reported that this method preserved gastric emptying and prevented the Roux stasis syndrome.In Japan, the uncut Roux operation is not yet considered an alternative method. Moreover, the use of the laparoscopic uncut Roux-en-Y gastrojejunostomy after distal gastrectomy has not been reported in the English-language literature. We performed 42 laparoscopic uncut Roux-en-Y gastrojejunostomies for gastric carcinoma. Here we describe the technical details and the initial results of our surgical technique. Method Operating-room setupUnder general anesthesia, each patient was placed in the supine position with the legs apart. A 20° head-up tilt was applied in order to prevent the transverse colon or small intestine from visually compromising the operative field. The surgeon stood on the patient's right, with the first assistant on the patient's left and the camera operator between the patient's legs. Surgical techniqueAfter pneumoperitoneum was established using the open technique, five ports were placed and a flexible electrolaparoscope was introduced through the infraumbilical port.The complete uncut Roux-en-Y gastrojejunostomy is illustrated in the schema in Fig. 1. This method is a modified Billroth II operation, which is accomplished by stapling across the afferent limb of the Billroth II gastrojejunostomy in continuity just proximal to the stomach and performing a side-to-side anastomosis for 40 cm between the afferent limb and the efferent limb, which is designated a "Braun enteroenterostomy".

Perioperative use of IEEF caused a significant increase in the total lymphocyte count at 3 and 5 days after operation and caused a shift toward B cell proliferation, which may possibly be beneficial to decrease the incidence of postoperative infectious complications.

Background: Although 2-dimensional strain analyses based on speckle tracking echocardiography have been used to detect myocardial deformation, the prognostic impact of 2-dimensional strain is unclear in patients with acute decompensated heart failure (HF). We investigated whether left ventricular and right ventricular (RV) strain parameters assessed by speckle tracking echocardiography provide incremental prognostic information in hospitalized patients because of acute decompensated HF. Methods and Results: Six hundred eighteen patients (age, 72±13 years; 38% women; ejection fraction, 46±16%) hospitalized for acute decompensated HF underwent clinical and echocardiographic evaluation just before discharge. We performed strain analyses of left ventricular global longitudinal strain and left ventricular global circumferential strain. We also analyzed RV longitudinal strain only from the free wall (RV-fwLS) and from all segments of the RV global longitudinal strain wall by using Tomtec software. The primary composite end point was cardiovascular death and readmission for HF. There were 34.8% cardiac events during a median follow-up of 427 days. In multivariate Cox models, among echocardiographic parameters, only impaired RV-fwLS (≥−13.1%; hazard ratio, 1.51; 95% CI, 1.12–2.04; P =0.01) was independently associated with cardiac events. Adding RV-fwLS to clinical risk evaluation (age, New York Heart Association class III/IV, blood urea nitrogen, and brain natriuretic peptide) markedly improved prognostic utility and consequently increased net reclassification improvement by 0.30 ( P =0.01). Conclusions: RV-fwLS is an independent predictor of cardiac events in acute decompensated HF and provides greater prognostic power than standard echocardiographic parameters.

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A number of enzymes have been shown to be involved in the process of activation and/or degradation of 5-fluorouracil (5-FU), and are potential candidates for predicting chemosensitivity to 5-FU. Among these, orotate phosphoribosyltransferase (OPRT EC 2.4.2.10) is a key enzyme related to the first-step activation process of 5-FU and has been shown to be an important enzyme that helps to predict sensitivity to 5-FU and its related derivatives. We developed a new enzyme-linked immunosorbent assay (ELISA) to accurately assess intratumoral activity of OPRT. A new sandwich ELISA was established using anti-OPRT polyclonal antibodies obtained from the rabbit immunized with the recombinant human peptides of the OPRT molecule. OPRT levels were measured in eight human cancer xenografts and in 75 gastric cancer tissues using both a newly established ELISA and a conventional enzyme assay, using radiolabeled 5-FU as a substrate. There was a significant correlation between OPRT levels measured by this ELISA and OPRT enzyme activity the in eight human cancer xenografts (r 2 = 0.782) and gastric carcinoma tissue (r 2 = 0.617). The ELISA system for OPRT requires a minimal amount of carcinoma tissue, making it an easy-to-use assay system to predict sensitivity to 5-FU and its derivatives in gastric carcinoma. There was a significant correlation between tumor growth inhibition rates against the oral administration of oral-uracil/tegafur (UFT) and OPRT enzyme activity in the human cancer xenografts (r 2 = 0.574). These results suggest that this newly developed sandwich ELISA system for the quantification of OPRT levels is technically simple, feasible and a useful tool to predict sensitivity to fluoropyrimidine-based anticancer chemotherapy in patients with gastric carcinoma and other cancers. A lthough 5-fluorouracil (5-FU) and its derivatives have been important anticancer agents and have been widely applied for patients with advanced gastrointestinal cancers, the overall response rate of 5-FU alone is still at best 10 -20% for gastric carcinoma.(1) Mechanisms of the anticancer effect, metabolic pathway and the enzymes involved in the metabolic process of 5-FU have been studied extensively (Fig. 1). A variety of attempts have been made to enhance anticancer effects and to reduce toxic effects by modulating enzymes involved in the metabolic pathway of 5-FU.(2) Some of the enzymes involved in the metabolic process of 5-FU, including thymidylate synthase and dihydropyrimidine dehydrogenase, have been shown to predict sensitivity to 5-FU and/or prognosis. (3,4) Based on the fact that the inhibitor of dihydropyrimidine dehydrogenase (DPD) has been shown to enhance the anticancer effects of 5-FU, (2) DPD-inhibitory fluoropyrimidines (DIF) have been developed to enhance anticancer effects.(2) To date, DIFs have played a major role in neoadjuvant and/or adjuvant chemotherapy for patients with advanced gastric carcinoma. (5) 5-FU administered in vivo is taken up by cancer cells and is phosphorylated to 5-fluorouridine-5′-monophosphate (FUMP...