systematic regional lymph node dissection over the past 11 years were analyzed.Gizo Nakagawara, M.D. RESULTS.The lymph node metastasis rate was 63.4% overall, 0% in pT1 disease, 61.9% in pT2 disease, and 81.3% in pT3/pT4 disease. When reviewed according to 1 Second Department of Surgery, Yokohama site, the rate was 41.5% in pericholedochal lymph nodes, 22.0% in the lymph nodes City University, School of Medicine, Yokohama, around the common hepatic artery and the portal vein, 36.6% in the posterior Japan.pancreaticoduodenal lymph nodes, 28% (5/18) in the celiac lymph nodes, 19% (3/ 2 First Department of Surgery, Fukui Medical 16) in the superior mesenteric artery (SMA) lymph nodes, and 26% (7/27) in the School, Fukui, Japan.aortocaval paraaortic lymph nodes. Patients with severe hepatoduodenal ligament invasion had high rates of paraaortic lymph node involvement. The mortality rate was 2.4% (1 of 41 patients) and the 5-year survival rate was 33.1% overall, 100% in patients with pT1 disease, 49.8% in patients with pT2 disease, and 0% in patients with pT3/pT4 disease. The 5-year survival rate for pT2 disease according to lymph node involvement was 72.7% in patients with pN0/ pN1/ positive posterior pancreaticoduodenal lymph nodes and positive lymph nodes around the common hepatic artery in the N2 patients and 0% in the patients with positive celiac and SMA lymph nodes in the N2 patient group or the positive paraaortic lymph node group (P õ 0.05). CONCLUSIONS.These results suggest that systemic dissection of N1 lymph nodes, posterior pancreaticoduodenal lymph nodes, and lymph nodes around the common hepatic artery and the portal vein in N2 patients is necessary to improve the prognosis of those patients with pT2 disease without moderate or severe hepatodu- proaches 37.0% with radical surgery, 4 and there are a few Japanese reports of long term survivors with advanced GBC who have lymph

This study investigated the relationship between atrial fibrillation (AF) and left ventricular (LV) geometric patterns in a hospital-based population in Japan. We retrospectively analyzed 4444 patients who had undergone simultaneous scheduled transthoracic echocardiography (TTE) and electrocardiography during 2013. A total of 430 patients who had findings of previous myocardial infarctions (n = 419) and without the data on body surface area (n = 11) were excluded from the study. We calculated the LV mass index (LVMI) and relative wall (RWT) and categorized 4014 patients into four groups as follows: normal geometry (n = 3046); concentric remodeling (normal LVMI and high RWT, n = 437); concentric hypertrophy (high LVMI and high RWT, n = 149); and eccentric remodeling (high LVMI and normal RWT, n = 382). The mean left atrial volume indices (LAVI) were 22.5, 23.8, 33.3, and 37.0 mm/m2 in patients with normal geometry, concentric remodeling, concentric hypertrophy, and eccentric hypertrophy, respectively. The mean LV ejection fractions (LVEF) were 62.7, 62.6, 60.8, and 53.8%, respectively, whereas the prevalence of AF was 10.4%, 10.5%, 14.8%, and 16.8% in patients with normal geometry, concentric remodeling, concentric hypertrophy, and eccentric hypertrophy, respectively. In conclusion, the prevalence of AF was increasing according to LV geometric remodeling patterns in association with LA size and LVEF.

The duration of anticoagulation therapy varied widely in discordance with current guideline recommendations. Optimal duration of anticoagulation therapy should be defined according to the risk of recurrent VTE and bleeding as well as death.

incidence compared with patients without cancer. VTE is reported to be the second most frequent cause of death in patients with cancer undergoing chemotherapy. 4 Furthermore, VTE in patients with cancer could develop through not only hypercoagulability with cancer, but also treatmentrelated factors including new molecular target therapeutic agents, which have further increased the risk for development of VTE in the current era. 5 A recent study reported Cancer is a progressive disease with a high mortality rate despite intensive treatment, but many cancer patients are surviving longer because of progress in early diagnosis and treatment. 1,2 Thus, complications during the treatment course of cancer are becoming more clinically relevant. Cancer is a strong risk factor for the development of venous thromboembolism (VTE), and patients with cancer are reported to have a 7-fold higher

Background-In ventricular myocardium, the T-type Ca 2ϩ current (I Ca,T ), which is temporarily observed during fetal and neonatal periods, has been shown to reappear in failing/remodeling hearts. However, its pathophysiological regulation has not been elucidated. Methods and Results-We utilized Dahl salt-sensitive (DS) rats with hypertension at the stage of concentric left ventricular (LV) hypertrophy (11 weeks old, LVH) and at the heart failure stage (16 to 18 weeks old, CHF). Some were treated with bosentan (100 mg/kg per day) during the period from LVH to CHF. In LVH, neither the presence of I Ca,T (measured in the freshly isolated LV myocytes) nor an increase in ␣-1G mRNA expression were detected. This condition was associated with increases in tissue angiotensin II (AII) but not with endothelin (ET)-1 peptides. In contrast, in CHF, when the tissue AII remained elevated and ET-1 de novo increased, I Ca,T was recorded in most of the cells (Ϫ0.87Ϯ0.18 pA/pF at Ϫ30 mV, PϽ0.01 versus LVH). This was associated with a significant increase in the ␣-1G mRNA level. The chronic bosentan treatment eliminated both the elevation of ␣-1G mRNA level and I Ca,T from the cells, whereas it did not affect the cell size and membrane capacitance. In addition, 48-hour exposure to ET-1 but not AII induced I Ca,T in normal adult myocytes in culture from Sprague-Dawley rats. Conclusions-I