Utility of palliative prognostic index and neutrophil-to-lymphocyte ratio in predicting prognosis of end-stage squamous cell carcinoma of head and neck.

BACKGROUND: The purpose of this study was to examine the factors influencing the prognosis of end-stage head and neck squamous cell carcinoma (HNSCC) and to develop a more useful prognostic index. PATIENTS AND METHODS: This retrospective observational study included 79 patients with end-stage HNSCC. Patients were grouped by patient factors and prognostic indicators, and overall survival from the start of Best Supportive Care was compared for each group. In addition, overall survival was compared between patients with palliative prognostic index (PPI) ≥6 and neutrophil-to-lymphocyte ratio (NLR) ≥10 and patients with PPI <6 or NLR <10. RESULTS: PPI ≥6 and NLR ≥10 were associated with significantly more frequent poor prognoses (p = 0.01 and p = 0.002, respectively). The median survival was 32 days in cases with PPI ≥6 and NLR ≥10, and 64 days for PPI <6 or NLR <10 (p < 0.001). CONCLUSION: The combination of PPI and NLR is a useful indicator for predicting the prognosis of patients with end-stage HNSCC.

A Delayed Cerebral Vasospasm with Infarction Is Secondary to Listeria monocytogenes Meningitis: MRI and MRA Are Diagnostically Useful.

Among patients with bacterial meningitis, a cerebral vasospasm typically occurs during the acute phase. We experienced a case of delayed cerebral vasospasm with infarction that was secondary to Listeria monocytogenes meningitis. An 82-year-old woman with Listeria monocytogenes meningitis, whose symptoms had been improving after the initiation of antibacterial therapy, fell into a coma on day 15 and developed generalized seizure. Magnetic resonance imaging (MRI) and MR angiography (MRA) indicated a cerebral vasospasm with multiple infarctions. The risk of vascular complications following acute bacterial meningitis requires close follow-up to identify neurological changes and a low threshold for vascular evaluation. In such cases, MRI and MRA have diagnostic utility.

[An evaluation of the current status and the reported problems of the cancer support group "Hidamari" in our hospital-results of a questionnaire survey completed by group participants].

PURPOSE: Peer support is a very important support intervention for cancer patients and their families. Our hospital has offered cancer support in the form of a support group "Hidamari" to cancer patients and their families since February 2012. This study analyzed and examined the current group status and the results of a questionnaire survey completed by group participants in order, to evaluate the functioning of the group and identify problems. METHODS: The current group status was determined as per the records of practice. A questionnaire survey that consisted of both multiple choice and open-ended questions was administered to the participants after the sessions. ETHICAL CONSIDERATIONS: The subjects were informed about the study purpose and confidentiality provisions in both oral and written forms, and return of the anonymous survey was considered to be consent. RESULTS: A group session was performed every 2 months(to date, a total of 4 sessions), and a total of 48 patients(68%)and 23 family members(32%)participated in the sessions. Each session included 9-25 subjects(mean: 17. 7 subjects/session). The response rate of the survey was 95. 8%. Responses to the question, "Are you satisfied with the sessions ?" were very satisfied, satisfied, dissatisfied, or very dissatisfied in 63%, 37%, 0%, and 0% of the participants, respectively. Responses to the question, "Do you wish to participate in further sessions ?" were yes, no, undecided, or gave no response in 94%, 0%, 2%, and 4% of the subjects, respectively. Reasons for satisfaction with the sessions were "It gives me courage and strength," "Useful information can be obtained," and "Good advice from nurses." DISCUSSION: All participants were satisfied with the sessions and most of the participants wished to participate in future sessions, indicating that the sessions had some positive effects. In future, we must consider initiatives covering the whole region, such as the implementation of a workshop that meets the needs of the participants and increases the number of participants with wider variety of cancer.

An autopsy case of secondary iron-overload cardiomyopathy.

A woman over 70 years of age presented with anemia and appetite loss. She had no history of blood transfusions, although she had been receiving iron infusions for anemia for seven years. She had an elevated serum ferritin level (7,951 ng/mL) one month before admission. Abdominal computed tomography showed increased hepatic density and echocardiography showed normal heart valves and heart-wall motion. The patient eventually experienced atrial tachycardia and atrial fibrillation and died of heart failure. An autopsy revealed iron deposits in the liver, pancreas, adrenal glands, thyroid gland, gastric mucosa and myocardium. Iron-overload cardiomyopathy was diagnosed based on the iron deposits, myocardial disarray and interstitial fibrosis.

Effects of toluene-2,4-diamine on red sea bream, Pagrus major: biochemical and histological evaluation.

The subacute toxicity of toluene-2,4-diamine (2,4-TDA) on marine fish was investigated in laboratory toxicity tests using red sea bream, Pagrus major. The fish were exposed to subacute concentrations of 2,4-TDA (measured concentrations: 0.0628, 0.234 and 0.878 mg/L) during the 14-day toxicity test and the effects on growth as well as on some biochemical parameters in the plasma, gills, liver and kidney structures were studied. The body weight and body length of the red sea bream exposed to the highest concentration were lower than those of the control. This study also showed a tendency towards decreases in three hematological parameters, i.e., the number of red blood cells, hemoglobin level and hematocrit, as well as blood chemical parameters in the plasma, i.e., the levels of total cholesterol, triglyceride, total protein and albumin, of fish exposed to the high concentrations. These findings were attributable to the reduced feeding of fish exposed to this concentration. In addition, cytoplasmic changes were observed in the cells of fish exposed to the highest concentration. It is suggested that the changes were caused by the decrease in feed efficiency derived from the exposure to 2,4-TDA.

Influence of dispersants on bioconcentration factors of seven organic compounds with different lipophilicities and structures.

Seven compounds with different lipophilicities and structures--1,3,5-trichlorobenzene, pentachlorobenzene, acenaphthylene, 1,4-dimethyl-2-(1-methylphenyl)benzene, 4-ethylbiphenyl, 4,4'-dibromobiphenyl, and 1,1,1-trichloro-2,2-bis(4-chlorophenyl)ethane--were subjected to bioconcentration tests in carp at concentrations below the water solubilities of the compounds in the presence or absence of a dispersant (either an organic solvent or a surfactant). The bioconcentration factors (BCFs) of the compounds were on the order of 10(2)-10(4). The BCF values remained in the range of 15-49% for all the compounds, whether or not a dispersant was present, i.e., the BCF values in the presence of an organic solvent or a surfactant at a concentration below the critical micelle concentration were not significantly smaller than the BCF values in the absence of the solvent or surfactant. This result indicates that the dispersants had no influence on the evaluation of the bioconcentration potential of these test substances.

Fish full life-cycle testing for androgen methyltestosterone on medaka (Oryzias latipes).

Abstract-We studied the chronic effects of methyltestosterone (MT) on reproductive status of medaka (Oryzias latipes) over two generations under continuous exposure to verify the applicability of the fish full life-cycle test (FFLC) for this androgen with this species. The exposure of parental (F0) medaka to MT was begun on embryos within 12 h postfertilization and continued for up to 101 d; assessment endpoints included embryological development, hatching, posthatch survival, growth, sexual differentiation, reproduction, and hepatic vitellogenin (VTG) levels under flow-through exposure to MT at each mean measured concentration of 0.35, 1.09, 3.29, 9.98, and 27.75 ng/L. Eggs (F1) spawned from the F0 fish at 98, 99, and 100 d posthatch were examined for hatchability, survival after hatching, growth, sexual differentiation, and hepatic VTG level until 60 d posthatch. In the FFLC with medaka, MT induced masculinization of both secondary sex characteristics and gonads. We observed that all F0 fish in the 27.75-ng/L treatment group showed male secondary sex characteristics in which no fish with ovary could be discerned. Several fish with ovaries in F0 and F1 generations treated with 9.98 ng/L showed male secondary sex characteristics. We also observed swollen abdomens in the F0 and F1 female fish in the 9.98-ng/L treatment group. These swollen abdomens were induced by enlarged ovaries and were accompanied with declined fecundity and fertility in the F0 generation. These results indicate that MT reduces the reproductive potential of medaka and that the FFLC with this species is applicable to the evaluation of androgens.

Effects of 4-nonylphenol on reproduction of Japanese medaka, Oryzias latipes.

We exposed mature Japanese medaka (Oryzias latipes) to 4-nonylphenol (4-NP) to elucidate its reproductive effects and estrogenic responses. For each treatment, eight breeding pairs were exposed for 3 weeks at measured 4-NP concentrations of 24.8, 50.9, 101, and 184 micrograms/L. Egg production of the pairs during the third week of exposure (15-21 d) was significantly decreased in the > or = 101-microgram/L treatment group, and fertility was significantly decreased in the 184-microgram/L group. Induction of testis-ova was observed in male fish at all 4-NP concentrations, whereas abnormality of spermatogenesis was found only in those receiving the 184-microgram/L treatment. The gonadosomatic index of the males in the 184-microgram/L group was also remarkably reduced. Hepatic vitellogenin (VTG) levels were significantly increased in both sexes receiving 4-NP treatments of > or = 50.9 micrograms/L. Overall, the lowest-observed effective concentrations (LOECs) of 4-NP for decreasing reproductive capacity (fecundity and fertility) and eliciting estrogenic responses (induction of testis-ova and VTG) were 101 and < or = 24.8 micrograms/L, respectively. The LOEC for reduced reproduction in medaka was at least four-fold greater than that required to elicit estogenic responses in male fish. Thus, we suggest that the estrogenic responses expressed in male fish are not responsible for the reduction in reproductive capacity.

Fish full life-cycle testing for the weak estrogen 4-tert-pentylphenol on medaka (Oryzias latipes).

We studied the chronic effects of 4-tert-pentylphenol (4-PP) on reproductive status of medaka (Oryzias latipes) over two generations under continuous exposure, with the goal of verifying the applicability of the fish full life-cycle test (FFLC) for this weak estrogen with this species. The exposure of parental (F0) medaka to 4-PP was begun on embryos within 12 h after fertilization and continued for up to 101 d, with monitoring of embryological development, hatching, posthatch survival, growth, sexual differentiation, reproduction, and hepatic vitellogenin (VTG) levels under flow-through exposure to 4-PP at mean measured concentrations of 51.1, 100, 224, 402, and 931 microg/L. Eggs (F1) spawned from the F0 fish at 99, 100, and 101 d after hatch also were examined for hatchability, survival after hatching, growth, sexual differentiation, and hepatic VTG levels, until 61 d after hatch. In the FFLC with the F0 medaka, the lowest-observed-effect concentration (LOEC) of 4-PP for lethal and sublethal toxicity (as shown by growth inhibition) was 931 microg/L. The LOECs for estrogenic effects (as shown by abnormal sexual differentiation and VTG induction) were 224 and < or = 51.1 microg/L, respectively, and the LOEC for reproductive impairment was 224 microg/L. Therefore, the effective concentrations of 4-PP for abnormal sexual differentiation and reproductive impairment were about four times lower than those for lethal and sublethal toxicity. In the F1 medaka, the LOECs for sublethal toxicity and estrogenic effects were 224 and < or = 51.1 microg/L, respectively. This finding suggests that the continuous exposure to 4-PP over two generations induced these adverse effects at lower concentrations in the F1 generation than those in the F0 generation. Thus, 4-PP has estrogenic effects that reduce the reproductive potential of medaka. The results indicate that the FFLC with medaka is applicable to the evaluation of weak estrogens.

Effects of 4-nonylphenol and 4-tert-octylphenol on sex differentiation and vitellogenin induction in medaka (Oryzias latipes).

Medaka (Oryzias latipes) were continuously exposed to various concentrations of two alkylphenols, 4-nonylphenol (NP) and 4-tert-octylphenol (OP), from fertilized eggs to 60 d posthatch. The effects on sexual differentiation and hepatic vitellogenin (VTG) induction in medaka were assessed to elucidate the lowest-observed-effect concentrations (LOECs) of NP and OP for these events during early life stages. The LOECs of NP and OP for these events were 11.6 and 11.4 microg/L, respectively. These results suggest that NP and OP may have adverse effects at similar concentrations during early life stage in medaka. Additionally, we investigated whether the abnormal sex differentiation induced by these alkylphenols would be permanent or reversible once the medaka were returned to clean water. The appearance of the secondary sex characteristics reverted from female to male when fish were returned to clean water. However, gonadal histology showed that intersex gonads still existed, even after the fish were transferred to clean water for two months. These results suggest that the induced feminization of secondary sex characteristics in medaka exposed to alkylphenols during the stage of sexual differentiation may not always be permanent, but the gonadal alteration (testis-ova) may continue much longer.

Unique bioconcentration characteristics of new aryl fluoroalkyl ethers in common carp (Cyprinus carpio).

The bioconcentration factors (BCFs) of seven new aryl fluoroalkyl ethers--four bis-4-tetrafluoroethoxyphenyl-type (bis-type) compounds and three mono-4-tetrafluoroethoxyphenyl-type (mono-type) compounds--were obtained by bioconcentration tests using common carp. The BCFs of 4 of the 7 ethers were higher than 5000, indicating their high bioconcentration potential. The bioconcentration characteristics of the bis-type compounds were different from those of the mono-type compounds and non-fluoro diphenylmethanes with a similar skeleton structure to the bis-type compounds, in taking longer to reach a plateau and having a slower elimination rate and in their distribution patterns in the fish body. The BCF of 1 bis-type compound was much higher than the value predicted by an accepted correlation equation between BCF and P(ow). In addition, the logP(ow) of the bis-type compounds calculated by commercially available computer software was remarkably different from that measured.

Effects of bisphenol a on the reproduction of Japanese medaka (Oryzias latipes).

We elucidated the effects of bisphenol A (BPA) on the reproductive capacity (fecundity and fertility) and estrogenic response of adult Japanese medaka (Oryzias latipes) and studied the transgenerational effects (F, generation growth and sex) of this agent on the F1 offspring. Eight mating pairs of medaka were exposed to BPA for three weeks at a measured concentration of 837, 1,720, or 3,120 microg/L. Throughout the exposure period, we observed no reduction of fecundity and fertility in any treatment group and no reduction in survival and growth or any imbalance of the sex ratio of the offspring. However, histologic examination revealed testis-ova in 13% of the males in the 837-microg/L treatment group, 86% of those in the 1,720-microg/L group, and 50% of those that received 3,120 microg BPA/L. In addition, concentrations of hepatic vitellogenin were increased significantly in males treated with BPA at 3,120 microg/L (p = 0.0148). These results suggest that BPA is a weakly estrogenic compound that has the potential to alter sexual development and induce vitellogenin in male medaka but that has no adverse effect on reproductive success.

Effect of ethinylestradiol on the reproduction and induction of vitellogenin and testis-ova in medaka (Oryzias latipes).

Mature medaka (Oryzias latipes) were exposed to ethinylestradiol (EE2) at measured concentrations of 32.6, 63.9, 116, 261, and 488 ng/L for 21 d under flow-through conditions. Effects on reproductive success of the fish as well as on gonadal condition and vitellogenin (VTG) induction were assessed. A significant decrease in fecundity was observed only at the highest EE2 concentration, whereas hepatic VTG concentration in males was increased at concentrations of 63.9 ng/L and greater. In addition, an intersex condition (testis-ova) of the gonad was observed in male medaka exposed to EE2 concentrations of > or = 63.9 ng/L. Overall, these results indicate that the lowest-observed-effect concentrations of EE2 based on reproduction versus induction of both VTG and testis-ova in the medaka were 488 and 63.9 ng/L, respectively. Thus, the physiological and histological measurements were approximately eightfold more responsive to the EE2 exposure than were overt reproductive effects. This suggests that the elevated VTG levels and testis-ova may not be definitely responsible for reproductive impairment of the fish.

Effect of 17beta-estradiol on the reproduction of Japanese medaka (Oryzias latipes).

Estrogenic compounds such as 17beta-estradiol (E2) and its analogs are present in the aquatic environment and can adversely affect the reproductive systems of aquatic organisms. Although E2 has been detected at a maximum concentration of 64 ng/l in effluents of sewage treatment works (STWs), few reports address the associated effects on reproduction in fish. Therefore, we exposed adult medaka (Oryzias latipes) to mean measured E2 concentrations of 29.3, 55.7, 116, 227, and 463 ng/l for 21 d and assessed the effects on the egg number and fertility of paired medaka during the exposure period. In addition, we determined the hepatic vitellogenin (Vtg) concentration and histologically assessed the gonads of these fish. The number of egg produced and fertility of the paired medaka exposed to 463 ng/l E2 were significantly less compared with those of the control fish. Males in all treatment groups had developed testis-ova. Males treated with E2 concentrations = 55.7 ng/l contained relating great concentrations of hepatic Vtg. Therefore, although only the greatest E2 concentration tested in our study affected fecundity and fertility, effects of E2 were observed on induction of Vtg and testis-ova in male medaka exposed to environmentally relevant concentrations of E2.