Gastric liposarcoma is an extremely rare tumour that usually affects the extremities and retroperitoneum. Preoperative diagnosis is difficult, and operative procedures are not well standardised. A 61-year-old woman presented with melaena, epigastric discomfort and palpitations. Upper endoscopy revealed a submucosal tumour at the posterior gastric fundus with an actively bleeding ulcer on the top. Our preoperative diagnosis was lipoma, and we performed laparoscopic intragastric surgery. However, the histopathological diagnosis was liposarcoma. Laparoscopic total gastrectomy was performed to achieve a wide surgical margin. Several recent series have shown that a positive microscopic margin is associated with a higher rate of local recurrence than a negative margin. We have added a staged operation to obtain a wide margin in cases involving a positive surgical margin. Preoperative diagnosis of liposarcoma is still challenging. Gastric lipoma-like tumours should be resected with a wide margin because of their possibility of malignancy.

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IntroductionTakotsubo cardiomyopathy is characterized by acute onset, reversible left ventricular apical wall motion abnormalities that simulate acute myocardial infarctions [1]. The clinical outcome is considered to be usually good, but severe complications such as cardiac rupture or fatal arrhythmias have been reported [2]. In this case, we used cibenzoline succinate, a class Ia sodium channel blocker that can be used to effectively attenuate the pressure gradient in patients with hypertrophic obstructive cardiomyopathy [3].Here, we present a patient with transient, severe left ventricular obstruction, associated with takotsubo cardiomyopathy which was successfully treated using cibenzoline succinate. Case reportAn 82-year-old woman was referred to our emergency department because of persistent malaise and accompanying chest pain, but without any associated somatic or psychological stress. A physical examination revealed her blood pressure 80/ 58 mmHg; body temperature 36.28; respiratory rate 25 min À1 ; oxygen saturation 97% on room air; and heart rate 124 bpm. A harsh 3/6 systolic murmur was heard along the left parasternal border, and fine crackles were audible in the bilateral lower lung fields. Her chest X-ray revealed cardiomegaly and congestion. Electrocardiography showed ST-segment elevation in II, III, aV F , and V 1-6 ( Fig. 1). Laboratory tests revealed an elevated white blood cell count (12,100 mm À3 ), positive heart-type fatty acid binding protein, and normal levels of creatinine kinase. Plasma level of brain natriuretic peptide was 852 pg/ml. Echocardiography demonstrated left ventricular apex akinesis and hyperkinesis of the basal area, leading to the suspicion of acute coronary syndrome or takotsubo cardiomyopathy. Hence, emergency coronary angiography was performed (Fig. 2), with the left and Journal of Cardiology Cases 11 (2015) 155-157 A B S T R A C TAn 84-year-old woman was urgently referred to our hospital owing to persistent malaise and chest pain. Takotsubo cardiomyopathy was diagnosed following transthoracic echocardiography, emergency coronary angiography, and left ventriculography. A left ventricular pressure tracing during cardiac catheterization revealed a 72 mmHg-intraventricular pressure gradient (LVPG). Although b-blockers are effective at reducing LVPG in takotsubo cardiomyopathy, such treatment was contraindicated in our patient owing to her history of bronchial asthma. Therefore, we administered intravenous cibenzoline succinate to attenuate her LVPG. The LVPG decreased to 18 mmHg within 10 min after intravenous cibenzoline succinate administration. During her subsequent hospitalization, the patient showed excellent functional recovery, without any complications. Left ventriculography, performed 21 days after admission, showed normal wall motion and a left ventricular ejection fraction of 68%.

Background & Aims: Hepatocyte sources that are expandable in vitro are required for liver regenerative medicine and to elucidate the mechanisms underlying the physiological functions of the liver. Liver ductal organoids (LDOs) comprise liver tissue stem cells with a bipotential capacity to differentiate into hepatocyte and cholangiocyte lineages, and can thus serve as a hepatocyte source. However, using current differentiation methods LDOs differentiate into immature hepatocytes while retaining strong cholangiocyte characteristics. We thus investigated an alternative differentiation method for LDOs to achieve hepatocyte maturation. Methods: We extracted 12 candidate transcription factors to induce hepatocyte differentiation by comparing their gene expression in LDOs and liver tissues. After evaluating the effects of these transcription factors on LDOs, we analyzed the comprehensive gene expression profile, protein expression, and hepatic function in the transduced organoids. Results: We identified a combination of four transcription factors, Hnf4a, Foxa1, Prox1, and Hlf, which upregulated hepatic lineage markers and downregulated cholangiocyte markers. Differentiation-induced LDOs showed more hepatocyte-specific characteristics than those with the conventional method, enhancing the transition from cholangiocyte to hepatocyte lineage and hepatic functions, such as liver-specific protein synthesis, lipid droplet deposition, and ammonia detoxification. Conclusion: Transduction of the four transcription factors (Hnf4a, Foxa1, Prox1, Hlf) is a promising strategy to promote the differentiation of LDOs to obtain mature hepatocyte-like cells with better functionality.

Three-dimensional scaffolds decellularized from native organs are a promising technique to establish engineered liver grafts and overcome the current shortage of donor organs. However, limited sources of bile duct cells and inappropriate cell distribution in bioengineered liver grafts have hindered their practical application. Organoid technology is anticipated to be an excellent tool for the advancement of regenerative medicine. In the present study, we reconstructed intrahepatic bile ducts in a rat decellularized liver graft by recellularization with liver ductal organoids. Using an ex vivo perfusion culture system, we demonstrated the biliary characteristics of repopulated mouse liver organoids, which maintained bile duct markers and reconstructed biliary tree-like networks with luminal structures. We also established a method for the co-recellularization with engineered bile ducts and primary hepatocytes, revealing the appropriate cell distribution to mimic the native liver. We then utilized this model in human organoids to demonstrate the reconstructed bile ducts. Our results show that liver ductal organoids are a potential cell source for bile ducts from bioengineered liver grafts using three-dimensional scaffolds.