Possible inhibitory effects of promotion stage treatment with thymosin fraction 5 on N-butyl-N-(4-hydroxybutyl)nitrosamine-initiated urinary tract carcinogenesis in NON/Shi mice.

The modifying effects of thymosin fraction 5 (TF5), a dialyzable glycoprotein extract obtained from calf thymus, on second stage urinary tract carcinogenesis after N-butyl-N-(4-hydroxybutyl)nitrosamine (BBN) initiation were investigated in NON/Shi male mice. BBN was administered for 8 weeks and then TF5 was administered subcutaneously twice a week for 12 weeks. The incidence of urinary bladder carcinomas was decreased in the TF5 treatment group, but the malignancy of the renal pelvic carcinomas appeared to be enhanced. We repeated the experiment to obtain confirmatory evidence, but found no significant effect, although TF5 did stimulate the immune surveillance system. The reason why this discrepancy occurred might be related to the degree of hydronephrosis or the confounding influence of renal pelvic carcinomas.

Transplantation of the en bloc vascular system for coronary revascularization.

OBJECTIVES: Use of the free gastroepiploic artery graft for coronary revascularization has not been very popular because of its inclination toward vasospasm. We hypothesized that the cause of free gastroepiploic artery spasm was the graft damage caused by an interruption of venous drainage from the graft. To solve this problem, we developed a new method of free gastroepiploic artery grafting. METHODS: From January 1997 to October 1999, 33 patients underwent coronary artery bypass grafting with the free gastroepiploic artery according to our new method. The gastroepiploic artery graft was harvested en bloc with its satellite veins. The gastroepiploic vein was anastomosed to the right atrial appendage for venous drainage simultaneously with the gastroepiploic artery being grafted in the aortocoronary position. RESULTS: A total of 96 distal anastomoses were performed, including 33 free gastroepiploic artery grafts according to our method, 33 in situ left internal thoracic artery grafts, 26 saphenous vein grafts, and 4 radial artery grafts. Neither operative nor hospital death occurred. Early postoperative angiography revealed that all of the 33 free gastroepiploic artery grafts performed with our method were patent without spasm, and flow competition occurred only in 2 of those grafts. On late angiography, all 15 free gastroepiploic artery grafts were patent without spasm. CONCLUSIONS: The free gastroepiploic artery grafting with venous drainage technique we developed can prevent graft spasm, leading to improved patency rate.

[Anesthesia for a child with congenital sensory neuropathy with anhydrosis].

We gave anesthesia twice to a 4-year-old boy with congenital sensory neuropathy with anhydrosis. At the first surgery, anesthesia was induced with midazolam and maintained with nitrous oxide, oxygen and sevoflurane 0.5-0.8% under mask breathing. Surgery was performed without any trouble but the patient vomited postoperatively for three days. Next time, anesthesia was induced and maintained with propofol under mask. The patient often moved during surgery, and therefore, we changed from propofol to oxygen and sevoflurane 1.0-1.5% anesthesia. Nitrous oxide was not used. After the surgery, no vomiting occurred.

[Late phase II clinical study of RP56976 (docetaxel) in patients with advanced/recurrent breast cancer].

A late phase II clinical study of RP56976 (Docetaxel), a new semisynthetic anticancer agent, was conducted in patients with advanced/recurrent breast cancer. RP56976 (Docetaxel) was in general administered at an intravenous dose of 60 mg/m2 with dose-free intervals of 3-4 weeks. Of the 74 patients enrolled, 64 patients completed the scheduled course of treatment. Three patients showed complete response (CR), 32 patients partial response (PR), 3 patients minor response (MR), 18 patients no change (NC), and 8 patients had progressive disease (PD). The overall response rate was 54.7%. The response rate in patients who previously had received chemotherapy was 55.7%, and the response rate in patients who had resistance to anthracycline agents or who did not respond to previous treatment was 58.7%. Adverse reactions included nausea/vomiting in 38 patients (57.6%), fatigue in 46 patients (69.7%), anorexia in 46 patients (69.7%), fever in 26 patients (39.4%), and alopecia in 60 patients (90.9%), all of which were tolerable. Abnormal laboratory findings included leukopenia (Grade III or more) in 57 patients (86.4%) and neutropenia (Grade III or more) in 56 patients (86.2%). The results show that RP56976 (Docetaxel) is an excellent agent with high antitumor effect for the treatment of advanced/recurrent breast cancer.

[Improvement of treatment of carcinoma of the thoracic esophagus, especially in reference to the transition in postoperative combined therapy].

It has become clear that postoperative combined therapy performed in our department has improved the prognosis of patients with carcinoma of the thoracic esophagus and changed the pattern of recurrence. In cases of postoperative radioimmunochemotherapy (a combination of 4000 rad of irradiation, with administration of 5-Fu and bleomycin, and the prescription of OK-432 and/or PSK after irradiation) was effective in preventing recurrence. In cases of n1(+) and n2(+), such therapy was effective in controlling local recurrence such as cervical and thoracic nodes. However, the 5-year survival rate of this group was 44.3%, indicating a need for more effective postoperative therapy. Thus, new radiochemoimmunotherapy (irradiation 4000R, 15-30mg/m2 x 2 CDDP, 2mg/body x 2 VDS) combined with three kinds of cytokines such as tumor necrosis factor (TNF), interleukin-II (IL-II) and interferon (IFN)-alpha has been applied in cases of n1(+), n2(+). Postoperative aggressive chemotherapies (old protocol, PAM treatment with a combination of Pepleomycin, Adriamycin and Mitomycin: Or new protocol, F.CAV treatment with a combination of 5-Fu, CDDP, Adriamycin and Vindesine) were effective in improving the prognosis of patients with n3(+) and n4(+). The 5-year survival rate improved from 2.7% with other therapies to 20. 5% with this therapy.

Pedometer-Based Behavioral Change Program Can Improve Dependency in Sedentary Older Adults: A Randomized Controlled Trial.

BACKGROUND: Recent studies suggested that pedometer-based walking programs are applicable to older adults. OBJECTIVES: The purpose of this study was to evaluate the use of pedometer in sedentary older adults to improve physical activity, fear of falling, physical performance, and leg muscle mass. DESIGN: This was a pilot randomized controlled trial (RCT). SETTING AND PARTICIPANTS: Eighty-seven community dwelling sedentary older adults living in Japan. INTERVENTION: The intervention group (n=43) received a pedometer-based behavioural change program for 6 months, while the control group (n=44) did not. The participants in the intervention group were instructed to increase their mean daily steps by 10% each month. Thus, at the end of 6 months, participants in the intervention group were expected to have 77 % more daily steps than their baseline step counts. Written activity logs were monthly averaged to determine whether the participants were achieving their goal. MEASUREMENTS: Outcome measures were physical activity, fear of falling, physical performances, and leg muscle mass. RESULTS: In this 6-month trial 40 older adults (93%) completed the pedometer protocol with good adherence. In the intervention group, average daily steps were increased by 83.4% (from 20311323 to 3726 1607) during the study period, but not in the control group (from 20471698 to 22671837). The pedometer-based behavioral change program was more effective to improve their physical activity, fear of falling, locomotive function, and leg muscle mass than control (P<0.05). CONCLUSION: These results suggested that the pedometer-based behavioral change program can effectively improve the physical activity, fear of falling, physical performance, and leg muscle mass in sedentary older adults.

2015 Recommendations for the management of polymyalgia rheumatica: a European League Against Rheumatism/American College of Rheumatology collaborative initiative

Therapy for polymyalgia rheumatica (PMR) varies widely in clinical practice as international recommendations for PMR treatment are not currently available. In this paper, we report the 2015 European League Against Rheumatism (EULAR)/American College of Rheumatology (ACR) recommendations for the management of PMR. We used the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology as a framework for the project. Accordingly, the direction and strength of the recommendations are based on the quality of evidence, the balance between desirable and undesirable effects, patients' and clinicians' values and preferences, and resource use. Eight overarching principles and nine specific recommendations were developed covering several aspects of PMR, including basic and follow-up investigations of patients under treatment, risk factor assessment, medical access for patients and specialist referral, treatment strategies such as initial glucocorticoid (GC) doses and subsequent tapering regimens, use of intramuscular GCs and disease modifying anti-rheumatic drugs (DMARDs), as well as the roles of non-steroidal anti-rheumatic drugs and non-pharmacological interventions. These recommendations will inform primary, secondary and tertiary care physicians about an international consensus on the management of PMR. These recommendations should serve to inform clinicians about best practices in the care of patients with PMR.(AU)

Fluconazole versus oral amphotericin B in preventing fungal infection in chemotherapy-induced neutropenic patients with haematological malignancies.

This open, randomized, controlled study was designed to assess the efficacy of fluconazole in comparison with oral amphotericin B in preventing clinically suspected fungal infection. A total of 178 chemotherapy-induced neutropenic episodes expected to last more than 10 days in 51 patients with haematological malignancies were randomly treated with fluconazole, 200 mg once a day, or amphotericin B, 800 mg three times a day orally. Defining the end points as (1) documented fungal infection or (2) use of empiric intravenous amphotericin B for suspected fungal infection including an episode of fever lasting more than 5 days or fever developed during the use of broad-spectrum antibiotics, no difference was observed between the two groups.

High-dose intravenous ribavirin therapy for subacute sclerosing panencephalitis.

Two patients with subacute sclerosing panencephalitis (SSPE) were treated safely and effectively with high doses of intravenous ribavirin combined with intraventricular alpha interferon. The ribavirin concentrations maintained in the serum and cerebrospinal fluid were higher than those which inhibit SSPE virus replication in vitro and in vivo.