Residual metastasis is a major cause of cancer-associated death. Recent advances in understanding the molecular basis of the epithelial–mesenchymal transition (EMT) and the related cancer stem cells (CSCs) have revealed the landscapes of cancer metastasis and are promising contributions to clinical treatments. However, this rarely leads to practical advances in the management of cancer in clinical settings, and thus cancer metastasis is still a threat to patients. The reason for this may be the heterogeneity and complexity caused by the evolutional transformation of tumor cells through interactions with the host environment, which is composed of numerous components, including stromal cells, vascular cells, and immune cells. The reciprocal evolution further raises the possibility of successful tumor escape, resulting in a fatal prognosis for patients. To disrupt the vicious spiral of tumor–immunity aggravation, it is important to understand the entire metastatic process and the practical implementations. Here, we provide an overview of the molecular and cellular links between tumors’ biological properties and host immunity, mainly focusing on EMT and CSCs, and we also highlight therapeutic agents targeting the oncoimmune determinants driving cancer metastasis toward better practical use in the treatment of cancer patients.

he intracoronary placement of metallic stents has been used to improve the results of balloon angioplasty for coronary lesions and to relieve acute or threatened occlusions from large dissections. [1][2][3] However, as a long-term therapeutic treatment of coronary artery disease, stenting remains limited because of the problem of recurring stenotic lesions (restenosis). The process of coronary arterial narrowing after stent implantation is mediated by neointimal proliferation in the stented coronary artery rather than by stent recoil or thrombus formation. Neointimal thickening may play a main role in the development of restenosis after stent implantation. [4][5][6][7] The in-stent restenosis rate has been reported to be 10-30%. [8][9][10][11][12] Recent technological progress has allowed the use of 2-dimensional intravascular ultrasound (IVUS) as an investigative technique in the cardiac catheterization laboratory. The IVUS technique allows tomographic imaging of the cross-sectional area of a coronary artery and characterization of the morphology of the intima, media, and adventitia of the coronary artery wall. 13 Therefore, IVUS is a useful method for evaluating neointimal thickening in stented coronary arteries but, because the acoustic impedance of in-stent neointima is similar to that of blood cells, occasionally there are some difficulties in differentiating lumen from in-stent neointima. This may be due partly because blood gives a strong backscatter signal, especially in areas with low blood flow. 14 In the present study, we used an echogenic contrast agent during IVUS (contrast IVUS) to evaluate a new technique that has the potential to improve the border detection of in-stent neointima. We also studied the reproducibility of IVUS measurements for an in-stent neointima area both with and without the use of an echogenic contrast agent and compared the results. Methods SubjectsThe study comprised 24 subjects (22 men and 2 women, 63±10 years of age) who had undergone an intracoronary stent implant with a Palmaz -Schatz stent at our hospital between August 1994 and May 1995, and whose stents were monitored by IVUS during the chronic phase [between the third and tenth month (mean 6.5±1.5 months)]. There were 20 cases of old myocardial infarction and 4 cases of angina pectoris. Stent placement had been conducted against restenosis after intervention in 16 cases, and against de novo lesions in 8 cases. Informed consent was obtained from all subjects prior to the study. Intracoronary StentingThe Palmaz -Schatz stent implanted in all patients was 15 mm in length. There were 3 types of stents of different diameters: (i) 3 mm stents were implanted in 14 patients; (ii) 3.5 mm stents were implanted in 9 patients; and (iii) a 4 mm stent was implanted in 1 patient. The patients' coronary arteries were the left anterior descending (LAD) in 13 cases, the left circumflex (LCX) in 1 case, and the right The present study evaluated a new technique that has the potential to improve the border detection of in-stent neointima ...

Carcinosarcomas, often referred to as malignant mixed tumors, are rare neoplasm. We reported herein a carcinosarcoma of the gallbladder in an elderly patient with long-term survival (4 years). The operation carried out was open cholecystectomy under the preoperative diagnosis of chronic cholecystitis and tumor of the gallbladder. Anticancer chemotherapy after cholecystectomy was performed by oral low-dose FT therapy. He was alive with no evidence of disease 48 months after surgery. Long-term survival for only cholecystectomy treatment as in this case may be possible if oral low-dose FT anticancer therapy is effective against carcinosarcoma of the gallbladder.

To clarify the significance of exercise BMIPP (beta-methyl iodophenyl pentadecanoic acid) and resting T1 delayed single photon emission computed tomography (SPECT) in the assessment of ischemia and viability, we studied maximal exercise-loading BMIPP SPECT following rest-injected T1 3 h SPECT in 11 control subjects, 20 patients with effort angina and 38 patients with old myocardial infarction. The left ventricular wall on ECT was divided into 9 segments. BMIPP and T1 uptake were scored as 0 = normal, 1 = reduced, 2 = severely reduced, or 3 = absent. Discordance was defined as when segments with a reduced BMIPP uptake had a better resting T1 uptake. Significant coronary artery stenosis was defined as stenosis of 75% or greater on coronary arteriogram. Left ventricular wall motion was assessed as either normokinesis, hypokinesis, severe hypokinesis, akinesis or dyskinesis on left ventriculogram. When discordance was considered to be a marker of ischemia, the sensitivity and specificity in effort angina and control subjects were 95.2% and 84.6% for patients and 83.9% and 94.4% for diseased vessels, respectively. There were no differences between the sensitivity and specificity in left anterior descending artery (LAD), left circumflex artery (LCx) and right coronary artery (RCA) lesions (83.3%, 95.5% in LAD, 83.3%, 95.5% in LCx, 85.7%, 92.6% in RCA, respectively). All of the patients with old myocardial infarction had reduced exercise BMIPP uptake in infarcted regions. In old myocardial infarction, 35 patients had segments with discordant uptake. Discordance was observed in 75 (91.5%) of 82 segments with hypokinesis, and in 24 (92.3%) of 26 segments with severe hypokinesis. Even among the 36 segments with akinesis or dyskinesis, 25 (69.0%) had discordant uptake. When discordance in the infarcted region was considered to be a marker of viability, regions with severe asynergy showed a high possibility of viability. Thus, discordant uptake on exercise BMIPP and resting T1 delayed SPECT may be a useful marker of ischemia in effort angina and of viability in old myocardial infarction.

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