Prognostic awareness in Japanese patients with advanced cancer: a follow-up cohort study.

BACKGROUND: Patients with advanced cancer have been reported to be more likely to receive goal-concordant care if they have accurate prognostic awareness. However, many patients do not have this awareness. This study aimed to examine the prognostic awareness among Japanese patients with advanced cancer. METHODS: This single-center, follow-up cohort study included Japanese patients with advanced cancer who received chemotherapy at Tohoku University Hospital between January 2015 and January 2016. Patients were surveyed at enrollment and followed up for clinical events for 5 years thereafter. We compared (i) the patients' prognostic awareness with both actual survival time and physician's prediction of survival and (ii) physician's prediction of survival time with actual survival. Factors associated with accurate prognostic awareness were identified by univariate analysis. RESULTS: Of the 133 patients eligible for the study, 57 patients were analyzed. Only 10 (17.5%) patients had accurate prognostic awareness. Forty-three patients (75.4%) were optimistic about their prognosis; >80% of patients were more optimistic than their physicians about their prognosis. The physicians' predictions were accurate in for patients (37.5%). Accurate prognostic awareness was associated with physician's explanation of the prognosis and patients' perception of a good death. CONCLUSIONS: A majority of the patients with advanced cancer in this study had prognostic awareness that was more optimistic in comparison with their actual survival, and most were more optimistic than their physicians about their prognosis. Further research is needed to develop programs to facilitate the discussion of life expectancy with patients in a manner that is consistent with their preferences.

Validation of the Japanese version of the full and short form Trust in Oncologist Scale.

OBJECTIVES: This study aimed to validate the Japanese versions of the Trust in Oncologist Scale (TiOS-J) and the TiOS-Short Form (TiOS-SF-J). METHODS: A cross-sectional web-based survey was conducted among cancer patients in Japan. The forward-backward translation method was used to develop the TiOS-J. The web-based survey was mailed to 633 people, of whom 309 responded. After 2 weeks, 103 among the 156 first-time respondents completed the second survey to verify the reliability of the retest method. The validity was evaluated by exploratory factor analysis (EFA), confirmatory factor analysis (CFA), Spearman's correlation coefficients between the Patient Satisfaction Questionnaire-Japanese, willingness to recommend the oncologist, trust in health care, and number of oncological consultations. To evaluate reliability, Cronbach's α and test-retest correlation were calculated. RESULTS: The theoretically driven four-factor model and the EFA-driven one-factor model of the full-form TiOS-J (18 items) did not result in an acceptable fit; however, CFA supported the one-dimensionality of the 5 items from the TiOS-SF-J (χ2 (5) = 12.36, p = 0.03, goodness-of-fit index = 0.984, adjusted goodness-of-fit index = 0.952, comparative fit index = 0.991, and root mean square error of approximation = 0.069). With regard to the reliability of TiOS-J and TiOS-SF-J, the Cronbach's alpha values were 0.94 and 0.89, respectively; the test-retest values were 0.82 and 0.78. SIGNIFICANCE OF RESULTS: This study indicated that the TiOS-J and TiOS-SF-J are valid and reliable instruments for measuring patients' trust in their oncologists and can be used to assess trust in oncologists for both clinical and research purposes.

Factors related to specialized palliative care use and aggressive care at end of life in Japanese patients with advanced solid cancers: a cohort study.

PURPOSE: This study aimed to (1) describe characteristics of aggressive care at the end of life (EOL) and (2) identify factors associated with specialized palliative care use (SPC) and aggressive care at the EOL among Japanese patients with advanced cancer. METHODS: This single-center, follow-up cohort study involved patients with advanced cancer who received chemotherapy at Tohoku University Hospital. Patients were surveyed at enrollment, and we followed clinical events for 5 years from enrollment in the study. We performed multivariate logistic regression analysis to identify independent factors related to SPC use and chemotherapy in the last month before death. RESULTS: We analyzed a total of 135 patients enrolled between January 2015 and January 2016. No patients were admitted to the intensive care unit, and few received resuscitation or ventilation. We identified no factors significantly associated with SPC use. Meanwhile, younger age (20-59 years, odds ratio [OR] 4.10; 95% confidence interval [CI] 1.30-12.91; p = 0.02) and no receipt of SPC (OR 4.32; 95% CI 1.07-17.37; p = 0.04) were associated with chemotherapy in the last month before death. CONCLUSION: Younger age and a lack of SPC were associated with chemotherapy at the EOL in patients with advanced cancer in Japan. These findings suggest that Japanese patients with advanced cancer may benefit from access to SPC.

Identifying factors predicting prolonged rehabilitation after simultaneous bilateral total knee arthroplasty: a retrospective observational study.

BACKGROUND: Rehabilitation is an effective procedure for promoting functional recovery after simultaneous bilateral total knee arthroplasty (TKA); however, it has been cited as a significant economic burden of medical care. We hypothesized that preoperative factors, including age, sex, body mass index, living alone, the knee society function score (KSS), the American society of anesthesiologists (ASA) class, hemoglobin (Hb), albumin level, mean range of motion, and the Kellgren-Lawrence grade, would predict prolonged rehabilitation utilization. METHODS: In total, 191 patients undergoing simultaneous bilateral TKA in a single hospital were enrolled. The successful compliance group included patients who completed their rehabilitation program and could return to their residence within 3 weeks after surgery (n = 132), whereas the delayed group included the remaining patients (n = 59). Logistic regression analysis was performed using preoperative factors. A prediction scoring system was created using the regression coefficients from the logistic regression model. RESULTS: Logistic regression analysis revealed that age (ß = - 0.0870; P <  0.01) and Hb (ß = 0.34; P <  0.05) were significantly associated with prolonged rehabilitation programs, whereas body mass index, living alone, KSS score, and ASA class were not significantly associated with successful completion of rehabilitation programs; however, these factors contributed to the prediction scoring formula, which was defined as follows: [Formula: see text] The C-statistic for the scoring system was 0.748 (95% confidence interval, 0.672-0.824). The positive and negative likelihood ratios were 2.228 (95% CI, 1.256-3.950) and 0.386 (95% CI, 0.263-0.566), respectively. These results showed an increase of 15-20% and a decrease of 20-25% in the risk of prolonged rehabilitation. The optimal cutoff point for balancing sensitivity and specificity was 3.5, with 66.6% sensitivity and 78.0% specificity. CONCLUSIONS: Older age and lower preoperative Hb were significantly associated with prolonged rehabilitation programs. We defined a new scoring formula using preoperative patient factors to predict prolonged rehabilitation utilization in patients undergoing simultaneous bilateral TKA.

Clinical course of 2019 novel coronavirus disease (COVID-19) in individuals present during the outbreak on the Diamond Princess cruise ship.

We investigated the clinical course of individuals with 2019 novel coronavirus disease (COVID-19) who were transferred from the Diamond Princess cruise ship to 12 local hospitals. The conditions and clinical courses of patients with pneumonia were compared with those of patients without pneumonia. Among 70 patients (median age: 67 years) analyzed, the major symptoms were fever (64.3%), cough (54.3%), and general fatigue (24.3%). Forty-three patients (61.4%) had pneumonia. Higher body temperature, heart rate, and respiratory rate as well as higher of lactate dehydrogenase (LDH), aspartate aminotransferase (AST), and C-reactive protein (CRP) levels and lower serum albumin level and lymphocyte count were associated with the presence of pneumonia. Ground-glass opacity was found in 97.7% of the patients with pneumonia. Patients were administered neuraminidase inhibitors (20%), lopinavir/ritonavir (32.9%), and ciclesonide inhalation (11.4%). Mechanical ventilation and veno-venous extracorporeal membrane oxygenation was performed on 14 (20%) and 2 (2.9%) patients, respectively; two patients died. The median duration of intubation was 12 days. The patients with COVID-19 transferred to local hospitals during the outbreak had severe conditions and needed close monitoring. The severity of COVID-19 depends on the presence of pneumonia. High serum LDH, AST and CRP levels and low serum albumin level and lymphocyte count were found to be predictors of pneumonia. It was challenging for local hospitals to admit and treat these patients during the outbreak of COVID-19. Assessment of severity was crucial to manage a large number of patients.

Preoperative soft tissue laxity around knee was associated with less accurate alignment correction after hybrid closed-wedge high tibial osteotomy.

PURPOSE: This study aimed to assess the effect of soft tissue correction due to knee joint laxity, which induces alignment error after hybrid closed-wedge high tibial osteotomy (CWHTO). In addition, to verify whether postoperative soft tissue correction can be predicted from preoperative radiographic parameters. METHODS: A retrospective evaluation of data from patients treated by CWHTO in 2016-2019 was performed. Standing full-length anteroposterior radiograph measurement was performed pre- and post-surgery, and short anteroposterior radiographs of the knee under maximal manual varus and valgus stress were taken preoperatively. The weight-bearing line, hip-knee-ankle angle (HKA), medial proximal tibial angle (MPTA), and joint line convergence angle (JLCA) were measured, in addition to JLCA under varus or valgus conditions. Soft tissue correction was defined as ΔHKA minus ΔMPTA. Multiple regression analysis was performed to evaluate preoperative factors that could influence soft tissue correction. RESULTS: Data from 49 knees were included in the analysis. The mean soft tissue correction was 3.2°, which indicates an over-correction. Multiple regression analysis revealed that JLCA (ß = 0.642; p < 0.001) and valgus JLCA (ß = - 0.422; p = 0.001) were significantly associated with postoperative soft tissue correction. The final model of the regression formula was described by the following equation: postoperative soft tissue correction = 0.691 × JLCA - 0.411 × valgus JLCA - 0.399. CONCLUSION: Preoperative values for JLCA and JLCA under valgus stress are associated with soft tissue correction. Surgeons should, therefore, consider these measurements to achieve postoperative limb alignment.

Effect of Flurbiprofen and S-Flurbiprofen Patches on Multimodal Pain Management After Total Knee Arthroplasty: A Prospective Randomized Controlled Trial.

BACKGROUND: Total knee arthroplasty (TKA) is an established procedure for knee osteoarthritis. Multimodal analgesia is reportedly more effective for postoperative analgesia. We investigated the efficacy of 2 patches after TKA. METHODS: Seventy-nine knees that underwent unilateral TKA for osteoarthritis were included. Oral administration, local periarticular analgesic injection, and patches were adopted for pain management. The knees were randomly assigned to the flurbiprofen patch (FPP), S-flurbiprofen patch (SFPP), and control (no patch) groups. Patch treatment was continued for 14 days. Pain according to the visual analog scale, knee flexion angle, renal dysfunction, gastrointestinal injury, duration of hospitalization, dermatitis, and the rate of using additional oral nonsteroidal anti-inflammatory drugs were compared (from preoperative to postoperative day 14). RESULTS: The FPP, SFPP, and control groups included 29, 27, and 23 knees, respectively. Visual analog scale was lower in the FPP and SFPP groups than in the control group on days 1 and 3 (day 1: 24.4, 25.0, and 39.4, respectively; day 3: 25.5, 23.3, and 39.3, respectively). Knee flexion angle was larger in the SFPP group than in the control group on days 7 and 14 (day 7: 89.8° and 76.6°, respectively; day 14: 98.3° and 84.2°, respectively). Neither renal dysfunction nor gastrointestinal injury was confirmed. The duration of hospitalization did not differ among the groups. Dermatitis occurred only in the SFPP group. The rate of using additional oral nonsteroidal anti-inflammatory drugs was higher in the control group. CONCLUSION: Both patches were effective and safe as part of multimodal analgesia for postoperative TKA.

Comparison Between 3-Dimensional Multiple-Echo Recombined Gradient Echo Magnetic Resonance Imaging and Arthroscopic Findings for the Evaluation of Acetabular Labrum Tear.

PURPOSE: To evaluate radially reconstructed 3.0-Tesla 3-dimensional multiple-echo recombined gradient echo (MERGE) magnetic resonance imaging (MRI) without arthrography for the assessment of acetabular labrum tears, using arthroscopic evaluation as the reference standard. METHODS: A total of 71 consecutive hips, including 29 with femoroacetabular impingement, 26 with borderline developmental dysplasia of the hip, and 16 with early-stage osteoarthritis, were evaluated in this retrospective study. MERGE MRI findings were evaluated according to the modified Czerny classification for 3 regions of interest: anterior region, anterolateral region, and lateral region. Cases with severe degeneration that was not concordant with any stage in the original Czerny classification were defined as stage Ⅳ. MERGE MRI findings were compared with arthroscopic findings, and the sensitivity, specificity, positive predictive value, and negative predictive value in terms of the existence of labrum tears were calculated. RESULTS: MERGE MRI findings revealed labrum tears more frequently in the anterolateral region than in the anterior and lateral regions (P < .01). In cases of femoroacetabular impingement and borderline developmental dysplasia of the hip in particular, labrum tears were more frequently observed on MRI in the anterolateral region than in the lateral region (P < .05). In comparison with MRI findings and arthroscopic findings, our newly defined stage IV in the modified Czerny classification was more frequently observed in cases with a Multicenter Arthroscopy of the Hip Outcomes Research Network (MAHORN) classification of degenerative or complex (P < .01). The average sensitivity and specificity of all regions for the existence of labrum tears were 85% and 56%, respectively. Sensitivity and specificity were 79% and 50%, respectively, in the anterior region; 96% and 50%, respectively, in the anterolateral region; and 70% and 57%, respectively, in the lateral region. CONCLUSIONS: We validated the diagnostic performance of 3.0-Tesla 3-dimensional MERGE MRI for evaluating acetabular labrum tears and made comparisons with arthroscopic findings. Radially reconstructed MERGE magnetic resonance images showed excellent sensitivity for the diagnosis of labrum tears, particularly in the anterolateral region. The newly defined stage IV was distinctive of early-stage osteoarthritis cases with degeneration and/or complex arthroscopic findings. The noninvasive imaging modality of radially reconstructed MERGE MRI may be an alternative to magnetic resonance arthrography for evaluating labrum tears. LEVELS OF EVIDENCE: Level Ⅱ, development of diagnostic criteria.

Patient perceptions of curability and physician-reported disclosures of incurability in Japanese patients with unresectable/recurrent cancer: a cross-sectional survey.

BACKGROUND: Although reports have described the perceptions of curability among patients with unresectable/recurrent cancer and the quality of death and dying, the association between patients' perceptions and physicians' disclosures of incurability remained unexplored. This survey aimed to evaluate the association between patients' perceptions of curability and physicians' disclosures of incurability. METHODS: In this cross-sectional, multicenter, observational study in Japan, we asked outpatients with unresectable/recurrent solid cancers about their perceptions of incurability. The patient inclusion criteria were unresectable/recurrent solid cancer, failure of first-line chemotherapy and an age ≥ 20 years. Additionally, we surveyed their primary responsible physicians regarding disclosures to patients regarding incurability. RESULTS: Although we estimated the necessary sample size as 250, we discontinued recruitment because the responsible researcher transferred to another hospital. Among the 135 included and surveyed patients, 39% responded that their cancer was incurable, 33% responded that their cancer was curable and 23% responded 'I don't know' or 'I don't wish to answer'. No significant association was observed between patients' perceptions of curability and physician-reported disclosures of incurability. CONCLUSION: In this Japanese population, 39% of patients with unresectable/recurrent solid cancers perceived that their cancers were incurable. However, such perceptions did not appear to be significantly affected by physician-reported disclosures. We recommend additional research to determine the best disclosure method to ensure that patients truly understand their disease status.

The Relationship Between the Location of Uptake on Positron Emission Tomography/Computed Tomography and the Impingement Point by Computer Simulation in Femoroacetabular Impingement Syndrome With Cam Morphology.

PURPOSE: To clarify the concordance rate of the location of uptake on positron emission tomography/computed tomography (PET/CT) and the impingement point demonstrated in computer simulation in femoroacetabular impingement (FAI) syndrome with cam morphology. METHODS: We included hip joints with FAI syndrome that underwent 18F-fluoride PET/CT. We also excluded hips with SUVmax <6. Each hip was evaluated for the region of the SUVmax point on PET/CT as well as the impingement point by computer simulation. We used ZedHip software (Lexi, Tokyo, Japan) for impingement simulation analysis based on CT data. Bony impingement is identified if there is a mesh in acetabular and femoral side contact in at least one unit. We investigated the rate of concordance between these 2 regions for each 10° flexion angle of the hip, ranging from 0° to 90°. RESULTS: Twenty-two hips of 22 patients were evaluated. The SUVmax region was most frequently distributed in the proximal middle region in 12 hips. In 18 of 22 hips (81.8%), the SUVmax region was concordant with the impingement region for at least one flexion angle. The concordance rates in 50° (P = .034), 60° (P = .007), 70° (P = .011), and 80° (P = .046) of flexion were significantly higher than in 90° of flexion. CONCLUSIONS: It was possible to visualize and clarify the detailed location of abnormal uptake in FAI syndrome patients with cam morphology by applying 18F-fluoride PET/CT. The concordance rates in 50°, 60°, 70°, and 80° of flexion were significantly higher than in 90° of flexion, which suggested that impingement may more frequently occur at less than 90° of flexion in FAI syndrome with cam morphology. LEVEL OF EVIDENCE: Level III, cross-sectional diagnostic study.

Efficacy and Safety Assessment of Paclitaxel in Patients with Docetaxel-Resistant Esophageal Squamous Cell Carcinoma.

BACKGROUND: Incomplete cross-resistances between paclitaxel (PTX) and docetaxel (DTX) has been demonstrated in several types of cancer. The objective of the present study was to assess the existence of cross-resistance between PTX and DTX in esophageal squamous cell carcinoma. METHODS: Patients in the PTX group received PTX without DTX pretreatment, patients in the prior DTX (Pr-DTX) group received PTX after the development of resistance to DTX, and patients in the DTX group received DTX without subsequent PTX treatment. RESULTS: A total of 73 patients were enrolled. The response rates to PTX in the PTX and Pr-DTX groups were 22.7 and 20.0%, respectively. The median progression-free survival times from the first day of PTX treatment in the PTX and Pr-DTX groups were 113 (95% CI 56-154) and 97 days (95% CI 36-189), respectively. The median overall survival times from the first day of DTX treatment in the Pr-DTX and DTX groups were 315 (95% CI 124-453) and 148 days (95% CI 139-177), respectively. CONCLUSIONS: There is no or incomplete clinical cross-resistance between PTX and DTX in esophageal squamous cell carcinoma. Replacement of DTX with PTX is a suitable treatment option for patients with DTX-resistant esophageal squamous cell carcinoma.

Validity and reliability of the Japanese version of the Patient Satisfaction Questionnaire (PSQ-J) for evaluating oncologist consultations.

Objective: To develop the Japanese version of the Patient Satisfaction Questionnaire (PSQ-J) and examine its validity and reliability. Methods: A cross-sectional, web-based survey was conducted among cancer patients in Japan. The PSQ-J was developed following the forward-backward translation method, using a numerical rating scale. Data on patient characteristics and psychometric scales, like the PSQ-J, willingness to recommend an oncologist to others, trust in the healthcare system, uncertainty, and the Physician Compassion Questionnaire were collected. Validity was examined using exploratory and confirmatory factor analyses and by calculating the correlations between the total PSQ-J score and the criterion variables. Reliability was confirmed by Cronbach's alpha and test-retest score correlations at a two-week interval. Results: The first and second surveys were conducted on 309 and 107 patients, respectively. One-dimensionality and model fit were verified using factor analyses. The PSQ-J was significantly associated with other comparable scales. Cronbach's alpha was 0.962; the correlation between the PSQ-J test-retest scores was 0.835 (p < .001). Conclusion: The current study indicates that the PSQ-J can be valid and reliable for assessing satisfaction with oncologist consultation. Innovation: The PSQ-J enables the effective assessment of patient satisfaction with oncologist consultations, leading to better practice reflecting the patient's viewpoint.

Phase II study of biweekly cetuximab plus mFOLFOX6 or mFOLFIRI as second-line treatment for metastatic colorectal cancer and exploratory analysis of associations between DNA methylation status and the efficacy of the anti-EGFR antibody: T-CORE1201.

Background: Little is known about the biweekly combined use of cetuximab and chemotherapy as second-line treatment of metastatic colorectal cancer (mCRC). Recently, DNA methylation status has been reported to be a new possible predictor of the efficacy from the anti-epidermal growth factor receptor (EGFR) antibody treatment. The purpose of this study was to examine the efficacy and safety of biweekly cetuximab plus mFOLFOX6 or mFOLFIRI as a second-line treatment for KRAS exon 2 wild-type mCRC. We also investigated the predictability of DNA methylation status on the efficacy of the EGFR antibody-containing treatment. Methods: Patients who were refractory or intolerant to the first-line chemotherapy were enrolled and received biweekly cetuximab plus mFOLFOX6 or mFOLFIRI. The primary endpoint was progression-free survival (PFS). Tumor evaluations were performed every 2 months using Response Evaluation Criteria in Solid Tumor (RECIST) version 1.1. Adverse events (AEs) were evaluated according to the Common Terminology Criteria for Adverse Events version 4.0. DNA methylation status of colorectal cancer cells was defined by a modified MethyLight assay. Results: Sixty-six cases were enrolled. The median PFS (mPFS) was 5.1 [95% confidence interval (CI), 3.8-7.6] months. The median overall survival (mOS) was 12.7 (95% CI, 7.5-15.3) months. Grade 3 or higher neutropenia occurred in 53.0% of patients, whereas skin disorders with a grade 3 or higher occurred in <15% of patients. In multivariate analysis, DNA methylation status could not be an independent predictor of PFS [hazard ratio (HR), 1.43; P=0.39] and OS (HR, 2.13; P=0.086). However, in RAS/BRAF wild-type patients, the mPFS and mOS in the low-methylated colorectal cancer (LMCC) group was numerically better than those in the highly-methylated colorectal cancer (HMCC) group, although the difference was not statistically significant [mPFS: 8.5 (95% CI, 6.1-10.9) vs. 3.3 (95% CI, 1.2-not reached) months, P=0.79; ΔmPFS, 5.2 months; mOS: 15.3 (95% CI, 11.9-23.5) vs. 6.5 (95% CI, 3.1-not reached) months, P=0.53; ΔmOS, 8.8 months]. Conclusions: Biweekly cetuximab plus mFOLFOX6 or mFOLFIRI is a useful second-line therapy for mCRC. DNA methylation status warrants further exploration as a predictive biomarker for anti-EGFR efficacy in mCRC.

Radiographs Are Comparable With 3-Dimensional Computed Tomography-Based Models as a Modality for the Preoperative Planning of the Arthroscopic Lateral Acromioplasty: A Retrospective Comparative Study.

Purpose: To compare plain radiographs with 3-dimensional (3D) computed tomography (CT) data for preoperative planning of arthroscopic lateral acromioplasty (ALA) for patients in whom ALA was performed along with arthroscopic rotator cuff repair (ARCR). Methods: Patients older than 25 years old who underwent ALA along with ARCR in our institution between October 2019 and February 2021 were included in this study. Preoperative ALA simulations were performed on plain radiographs and 3D models based on CT data. The critical shoulder angle (CSA) was compared between simulations based on radiographs and those based on 3D models. The ALA procedure was performed using the 3D model simulation, along with ARCR. The CSA after surgery was investigated using radiographs. Results: We evaluated 11 shoulders in 10 patients. There was no significant difference between the mean preoperative CSA on radiographs and 3D models (38.0° ± 2.6° vs 38.6° ± 1.8°, respectively; P = .55). The mean CSA after 4-mm ALA simulation using radiographs was not significantly different to that using 3D models (34.1° ± 2.6° vs 34.3° ± 2.5°, respectively; P = .84). Four cases (36.4%) required 8-mm ALA to reduce the CSA to <35° on radiographic analysis, and 2 (18.2%) required 8-mm ALA on 3D model analysis. The mean CSA on postoperative radiographs was significantly smaller than that on preoperative radiographs (32.1° ± 2.7° vs 38.0° ± 2.6°, respectively; P < .01). Conclusions: There was no significant difference between the mean CSA after a 4-mm ALA simulation using radiographs and that using 3D models based on preoperative CT data, which suggests that radiographs are comparable with 3D CT data models as a reliable modality for the preoperative simulation of ALA. Level of Evidence: III, retrospective comparative study.

Effect of Decreasing the Anterior Pelvic Tilt on Range of Motion in Femoroacetabular Impingement: A Computer-Simulation Study.

BACKGROUND: The influence of pelvic tilt mobility, which can be reproduced in computer-simulation models, is an important subject to be addressed in the understanding of femoroacetabular impingement (FAI) pathophysiology. PURPOSE: To use computer-simulation models of FAI cases to evaluate the optimum improvement in hip range of motion (ROM) achieved by decreasing the anterior pelvic tilt and compare the results with the improvement in ROM achieved after cam resection surgery. STUDY DESIGN: Controlled laboratory study. METHODS: The pre- and postoperative computed tomography (CT) images from 28 patients with FAI treated with arthroscopic cam resection were evaluated. Using a dynamic computer-simulation program, 3-dimensional models with a 5° and a 10° decrease in anterior pelvic tilt from the supine functional pelvic plane (baseline) were created from the preoperative CT scans. Similar models were constructed for hips before (at baseline) and after cam resection. Improvements from baseline in maximum internal rotation at 45°, 70°, and 90° of flexion were assessed for the 5° change in pelvic tilt, 10° change in pelvic tilt, and cam resection models, and the results were compared for all conditions. RESULTS: The combination of a 10° change in pelvic tilt and cam resection showed the largest ROM improvement from baseline (P < .001). Improvement in internal rotation in the cam resection model was significantly higher compared with the 5° pelvic tilt change model (P < .001), while there was no significant difference between the cam resection model and the 10° pelvic tilt change model. CONCLUSION: Decreasing anterior pelvic tilt by 10° in the preoperative computer simulation model resulted in an equivalent effect to cam resection, while a 5° change in pelvic tilt was inferior to cam resection in terms of ROM improvement. CLINICAL RELEVANCE: Enough of a decrease in anterior pelvic tilt may contribute to ROM improvement that is as effective as that of cam resection surgery.

Patients' understanding of communication about palliative care and health condition in Japanese patients with unresectable or recurrent cancer: a cross-sectional survey.

BACKGROUND: Understanding treatment goal is essential for decision-making among patients with unresectable/recurrent solid cancers. However, no previous studies in Japan have examined the association between patients' understanding and physicians' explanations. We aimed to examine agreement between patients' and physicians' reports of communication about palliative care and current health condition among patients with unresectable/recurrent cancer and explore factors associated with optimistic understanding in Japan. METHODS: In this cross-sectional, multicenter, observational survey in Japan, 178 patients with unresectable/ recurrent solid cancers and 16 physicians responded to questionnaires. The primary outcome was agreement between patients' and physicians' reports of communication about palliative care and current health condition. RESULTS: Of 56 patients who reported their communication about palliative care, 25/56 (44.6%) agreed with physician reports, and 31/56 (55.4%) were more optimistic than their physicians. Regarding current overall health condition, 45/122 (36.9%) patients gave reports that agreed with physicians' reports, and 77/122 (63.1%) were optimistic relative to physicians. Physicians' general approach about disclosure were not associated with patients' understanding. CONCLUSIONS: Fewer than 50% of Japanese patients with unresectable/recurrent cancer agreed with their physicians, whereas most others were more optimistic about palliative care communication and their health condition as compared to physicians. Effective communication is essential to ensure informed decisionmaking.

A newly established monoclonal antibody against ERCC1 detects major isoforms of ERCC1 in gastric cancer.

Identifying patients resistant to cisplatin treatment is expected to improve cisplatin-based chemotherapy for various types of cancers. Excision repair cross-complementing group 1 (ERCC1) is involved in several repair processes of cisplatin-induced DNA crosslinks. ERCC1 overexpression is reported as a candidate prognostic factor and considered to cause cisplatin resistance in major solid cancers. However, anti-ERCC1 antibodies capable of evaluating expression levels of ERCC1 in clinical specimens were not fully optimized. A mouse monoclonal antibody against human ERCC1 was generated in this study. The developed antibody 9D11 specifically detected isoforms of 201, 202, 203 but not 204, which lacks the exon 3 coding region. To evaluate the diagnostic usefulness of this antibody, we have focused on gastric cancer because it is one of the major cancers in Japan. When ERCC1 expression was analyzed in seventeen kinds of human gastric cancer cell lines, all the cell lines were found to express either 201, 202, and/or 203 as major isoforms of ERCC1, but not 204 by Western blotting analysis. Immunohistochemical staining showed that ERCC1 protein was exclusively detected in nuclei of the cells and a moderate level of constant positivity was observed in nuclei of vascular endothelial cells. It showed a clear staining pattern in clinical specimens of gastric cancers. Antibody 9D11 may thus be useful for estimating expression levels of ERCC1 in clinical specimens.

A nuclear receptor, hepatocyte nuclear factor 4, differently contributes to the human and mouse angiotensinogen promoter activities.

Angiotensinogen (AGT), mainly produced in the liver, is the precursor of angiotensin II, an important regulator of blood pressure and electrolyte homeostasis. We previously showed, in hepatoma-derived HepG2 cells that a hepatocyte nuclear factor 4 (HNF4) potentiated human AGT (hAGT) promoter activity and identified its binding sites (termed regions C and J) in the hAGT promoter region. We also showed in transgenic mouse (TgM) that the hAGT is abundantly expressed in the kidney where the level of endogenous mouse AGT (mAGT) expression is low. To elucidate molecular mechanisms of the AGT gene activation in the kidney, we first investigated the HNF4 and AGT expression in the mouse kidney. Northern blot, in situ hybridization and immunohistochemical analyses revealed that the hAGT and HNF4 were both expressed in the proximal tubular (PT) cells of the kidney. We then transfected the hAGT reporter constructs into immortalized mouse PT (mProx) cells and found that regions C and J contributed additively to the HNF4-potentiated hAGT promoter activity. Curiously, no obvious HNF4 binding motif was found in the corresponding region of the mAGT promoter and co-transfected HNF4 failed to activate this promoter in neither HepG2 nor mProx cells. These results suggest that the high-level hAGT expression in the TgM kidney is, at least in part, due to a presence of high-affinity HNF4 binding sites in its promoter.

Prevalence of groin pain in unicycle athletes: A nationwide questionnaire survey.

BACKGROUND AND PURPOSE: This nationwide questionnaire survey was performed to clarify the prevalence of groin pain in unicycle athletes and to reveal the relationship between groin pain and factors such as age or athletic career. PATIENTS AND METHODS: To evaluate the prevalence of groin pain, the questionnaire was sent to 1304 unicyclists belonging to the Japan Unicycle Association. All subjects aged 6 years or older at the time they answered the questionnaire. RESULTS: Overall, 17% of unicyclists complained of groin pain. Pain was more common in those aged 13-19 years and in those with a career lasting more than 6 years. CONCLUSION: The incidence of groin pain (17%) among unicyclists is higher than that among athletes participating in other sports. Unicyclists aged between 13 and 19 years old and those with an athletic career of more than 6 years often suffer from groin pain.

Correlations and Reproducibility Between Radiographic and Radial Alpha Angles in the Evaluation of Cam Morphology.

BACKGROUND: The alpha angle used to evaluate cam morphology can be determined on different imaging views; however, 2-dimensional (2D) imaging can present limitations in terms of the reproducibility of the radial alpha angle. Recent developments in 3-dimensional (3D) high-resolution magnetic resonance imaging (MRI) have allowed detailed evaluations of the radial alpha angle. PURPOSE: To determine whether there are any correlations or discrepancies between the 2D alpha angle on plain radiography and the maximum radial alpha angle on 3D MRI. STUDY DESIGN: Cohort study (diagnosis); Level of evidence, 2. METHODS: A total of 42 hips from 39 patients (19 males, 20 females) were analyzed, including 22 hips with femoroacetabular impingement (FAI; mean age, 41 years) and 20 hips with borderline developmental dysplasia of the hip (BDDH; mean age, 43 years). Radial images were reconstructed from 3D multiple echo recombined gradient echo (MERGE) MRI. Differences in the maximum radial alpha angle on MRI between hips with FAI and BDDH were evaluated. Correlations and discrepancies between the maximum radial alpha angle on MRI and alpha angles on the anteroposterior, cross-table lateral, and 45° Dunn views of radiography were also evaluated. RESULTS: The maximum radial alpha angle was significantly higher for hips with FAI than for hips with BDDH. On average, the greatest alpha angle on radial MRI was higher than the alpha angle on each of the 3 radiographic views for both FAI and BDDH. The 45° Dunn view revealed the smallest discrepancy for both FAI (P = .005) and BDDH (P = .002). The cross-table lateral view had the highest correlation with the maximum radial alpha angle for BDDH (P < .001). CONCLUSION: We reconfirmed the utility of the 45° Dunn view, with it presenting the best reproducibility for the maximum radial alpha angle in the evaluation of cam morphology, while the cross-table lateral view revealed the best correlation with the maximum radial alpha angle, particularly for hips with BDDH.