Effect of Levofloxacin on the Efficacy and Adverse Events in Intravesical Bacillus Calmette-Guerin Treatment for Bladder Cancer: Results of a Randomized, Prospective, Multicenter Study.

BACKGROUND: Although bacillus Calmette-Guerin (BCG) is a standard treatment for high-risk non-muscle-invasive bladder cancer (NMIBC), a high rate of adverse events with a variety of grades remains a difficulty. OBJECTIVE: In this randomized, prospective, multicenter study, we examined whether levofloxacin, given after each intravesical instillation of BCG, could improve its tolerance in patients with intermediate- to high-risk urothelial carcinoma of the bladder without compromising its efficacy. DESIGN, SETTING, AND PARTICIPANTS: Overall, 106 Japanese patients (85 men and 21 women; age: median, 69.5 yr) with primary or recurrent NMIBC were randomized after transurethral resection to induce treatment with intravesical BCG plus levofloxacin (group 1) or BCG alone (group 2). INTERVENTION: Patients who underwent intravesical instillation of BCG were randomized with or without levofloxacin administration. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Adverse events were assessed using the National Cancer Institute-Common Toxicity Criteria version 3.0. Cumulative incidence functions and Kaplan-Meier methods were applied to estimate survival outcomes. RESULTS AND LIMITATIONS: There was no significant difference in baseline characteristics between the groups. The completion rate of group 1 (85.5%) was not significantly lower than that of group 2 (76.5%; p = 0.321). There was no significant difference in the completion rate of patients with pollakisuria, painful micturition, gross hematuria, fever elevation, and others between the groups. The incidence of adverse events in patients with high-grade pollakisuria (7.3% vs 25.4%, p = 0.041) and fever (0% vs 9.1%, p = 0.034) was significantly lower in group 1. The 5-yr progression-free and cancer-specific survival rates were significantly better in group 1. CONCLUSIONS: Prophylactic levofloxacin administration may reduce the severity of adverse events and contribute to better outcomes from BCG intravesical therapy in patients with NMIBC. PATIENT SUMMARY: Levofloxacin administration seems to be a safe and effective therapy for non-muscle-invasive bladder cancer patients treated with bacillus Calmette-Guerin intravesical therapy.

Augmented Self-Association by Electrostatic Forces in Thienopyrrole-Fused Thiadiazoles that Contain an Ester instead of an Ether Linker.

During the self-assembly of π-conjugated molecules, linkers and substituents can potentially add supportive noncovalent intermolecular interactions to π-stacking interactions. Here, we report the self-assembly behavior of thienopyrrole-fused thiadiazole (TPT) fluorescent dyes that possess ester or ether linkers and dodecyloxy side chains in solution and the condensed phase. A comparison of the self-association behavior of the ester- and ether-bridged compounds in solution using detailed UV-vis, fluorescence, and NMR spectroscopic studies revealed that the subtle replacement of the ether linkers by ester linkers leads to a distinct increase in the association constant (ca. 3-4 fold) and the enthalpic contribution (ca. 3 kcal mol-1 ). Theoretical calculations suggest that the ester linkers, which are in close proximity to one another due to the π-stacking interactions, induce attractive electrostatic forces and augment self-association. The self-assembly of TPT dyes into well-defined 1D clusters with high aspect ratios was observed, and their morphologies and crystallinity were investigated using SEM and X-ray diffraction analyses. TPTs with ester linkers exhibit a columnar liquid crystalline mesophase in the condensed phase.

Addition of S-1 to radiotherapy for treatment of T2N0 glottic cancer: Results of the multiple-center retrospective cohort study in Japan with a propensity score analysis.

OBJECTIVES: This multicenter retrospective cohort study aimed to evaluate the significance of adding S-1 to radiotherapy (RT) for the treatment of T2N0 glottic cancer using a propensity score matched analysis in Japan. MATERIALS AND METHODS: This study was conducted on 287 patients with T2N0 glottic cancer who were treated with definitive RT or chemoradiotherapy with S-1 (S-1 RT) between April 2007 and March 2017. Propensity score matched analysis was performed to ensure the well-balanced characteristics of the groups of patients who received RT alone and S-1 RT. Overall, progression-free and laryngectomy-free survivals and local control and laryngeal preservation rates were compared. RESULTS: Fifty-four pairs of patients were selected after performing propensity score matched analysis. Clinical characteristics were well-balanced between the two groups. The overall survival of patients in the S-1 RT group was significantly better than those in the RT alone group (P = 0.008). The progression-free and laryngectomy-free survivals of patients in the S-1 RT group were also better than those in the RT alone group; however, the differences were not significant. In contrast, patients in the S-1 RT group had slightly lower local control and laryngeal preservation rates compared with those in the RT alone group. The incidence of dermatitis in the S-1 RT group was significantly higher than that in the RT alone group in the matched population (P = 0.013). CONCLUSIONS: The addition of S-1 to RT for the treatment of T2N0 glottic cancer was not associated with better local control and laryngeal preservation rates in this study.

[Our experience with percutaneous trans-esophageal gastrotubing (PTEG)].

Percutaneous endoscopic gastrostomy (PEG) has been generally used as a long-term enteral nutrition route for patients in whom oral intake is impossible. Percutaneous trans-esophageal gastrotubing (PTEG) is useful for the patients in whom PEG insertion has not been indicated. A gastroenterologist usually performs PTEG in Japan, but in our hospital otolaryngologists have performed this procedure. From 2006 to 2012, we experienced 9 patients who underwent PTEG insertion without a life-threatening adverse event. An otolaryngologist who is accustomed to the cervical procedures can safely perform PTEG insertion.

Hierarchical nested wrinkles on silica-polymer hybrid films: stimuli-responsive micro periodic surface architectures.

Stimuli-response on hierarchically-structured surface wrinkles is required for advanced filtration, catalysis and sensing applications. Although conventional processes can form hierarchical surface wrinkles, incorporation of stimuli-responsive features has not been achieved, limiting the potential multi-scale functionality of wrinkles. Here, we demonstrate a novel process that can fabricate stimuli-responsive surface hierarchical structures on silica-polymer hybrid films through precisely controlled UV-polymerization and sol-gel condensation. Starting from uniform hybrid films, UV excitation of the film surface triggers the formation of micrometre-scale wrinkles with dual periodicity. Hierarchical nested wrinkle (NW) structures with controllable periodic lengths at discrete size scales of < 10 µm and > 23 µm show a shape-memory effect with changes in the surrounding humidity. Moreover, the individual responses of wrinkles with different periodicities can be controlled independently. As a proof-of-concept application, we demonstrate that the NW structures are an active size-selective adsorption/release surface for micrometre-sized particles.

Catatonia induced by idiopathic hypertrophic pachymeningitis.

We describe the case of a 63-year-old woman with catatonia induced by idiopathic hypertrophic pachymeningitis (IHP). The patient was treated for IHP with prednisolone for approximately 1 year. When she presented with catatonia, no significant changes could be detected by magnetic resonance imaging (MRI) compared with the previous imaging results; electroencephalography (EEG) revealed a delta-wave focus over the left frontotemporal region. High-dose steroid therapy was effective in resolving the catatonic symptomatology and EEG abnormality.

Effects of nicorandil on the cAMP-dependent Cl- current in guinea-pig ventricular cells.

In guinea-pig cardiomyocytes, a cAMP-dependent Cl(-) current (I(Cl,cAMP)) flows through a cardiac isoform of the cystic fibrosis transmembrane conductance regulator (CFTR), which belongs to a family of the ATP-binding cassette (ABC) proteins. Although several K(+)-channel openers and sulfonylurea ATP-sensitive K(+) (K(ATP))-channel blockers reportedly inhibit I(Cl,cAMP), effects of nicorandil on the Cl(-) current have not been evaluated. This study was conducted to examine the effects of nicorandil on I(Cl,cAMP) in isolated guinea-pig ventricular cells using patch clamp techniques. Nicorandil in concentrations higher than 300 microM enhanced the I(Cl,cAMP) preactivated by 0.1 microM isoproterenol. The isoproterenol-induced I(Cl,cAMP) was inhibited by 100 microM glibenclamide, but not by 100 microM pinacidil. SNAP (S-nitroso-N-acetyl-D,L-penicillamine, 10 microM), a nitric oxide (NO) donor, similarly enhanced the isoproterenol-induced I(Cl,cAMP). However, SG-86, a denitrated metabolite possessing K(+ )channel-opening action, failed to enhance the Cl(-) current. When the I(Cl,cAMP) was activated by 3-isobutyl-1-methylxanthine (IBMX, 30 microM), either nicorandil or SNAP failed to enhance the isoproterenol-induced I(Cl,cAMP). Thus, nicorandil enhances I(Cl,cAMP) in guinea-pig cardiomyocytes through an increase in intracellular cGMP, although direct modulation of I(Cl,cAMP) by NO cannot be completely excluded.

Repeated electroconvulsive therapy courses improved chronic regional pain with depression caused by failed back syndrome.

BACKGROUND: Electroconvulsive therapy (ECT) is reported to be effective for intractable chronic pain with depression. However, not much has been done to clarify the ECT target in patients, whether the pain or the depression. We report a case of intractable chronic regional pain syndrome (CRPS) with secondary depression in which the depression was treated successfully with an initial acute ECT course, and the pain finally improved with two additional ECT courses. CASE REPORTS: The patient was a 48-year-old woman with CRPS and depression caused by failed back syndrome. The CRPS with depression did not respond to standard treatments. A course of bilateral acute ECT (12 sessions) improved the depressive symptoms but not the pain. The depression relapsed 1 month after the response to ECT. A second course of acute ECT (20 sessions) followed by continuation ECT (11 sessions) improved the depression but not the pain. The depression recurred 1 year after the response to acute ECT. A third course of acute ECT (12 sessions) finally improved the pain and resolved the depression. CONCLUSIONS: Our experience in thin case suggests that the therapeutic target in patients with chronic organic pain and secondary depression should be the pain; repeated ECT courses are likely to be effective for the pain, although the depression may resolve first.

A case of catatonia resembling frontotemporal dementia and resolved with electroconvulsive therapy.

We describe a case of catatonia in a 51-year-old man in whom the catatonic symptoms could not be distinguished from symptoms of frontotemporal dementia (FTD) until they were resolved with electroconvulsive therapy (ECT). When it is difficult to distinguish between catatonia and FTD in patients with frontal dysfunction associated with frontal lobe atrophy, we believe that sequential administration of benzodiazepines and ECT is important for therapeutic diagnosis because the risk of missing a diagnosis of catatonia outweighs the risks associated with administration of benzodiazepines and/or ECT.

Rice OsYSL15 is an iron-regulated iron(III)-deoxymugineic acid transporter expressed in the roots and is essential for iron uptake in early growth of the seedlings.

Graminaceous plants take up iron through YS1 (yellow stripe 1) and YS1-like (YSL) transporters using iron-chelating compounds known as mugineic acid family phytosiderophores. We examined the expression of 18 rice (Oryza sativa L.) YSL genes (OsYSL1-18) in the epidermis/exodermis, cortex, and stele of rice roots. Expression of OsYSL15 in root epidermis and stele was induced by iron deficiency and showed daily fluctuation. OsYSL15 restored a yeast mutant defective in iron uptake when supplied with iron(III)-deoxymugineic acid and transported iron(III)-deoxymugineic acid in Xenopus laevis oocytes. An OsYSL15-green fluorescent protein fusion was localized to the plasma membrane when transiently expressed in onion epidermal cells. OsYSL15 promoter-beta-glucuronidase analysis revealed that OsYSL15 expression in roots was dominant in the epidermis/exodermis and phloem cells under conditions of iron deficiency and was detected only in phloem under iron sufficiency. These results strongly suggest that OsYSL15 is the dominant iron(III)-deoxymugineic acid transporter responsible for iron uptake from the rhizosphere and is also responsible for phloem transport of iron. OsYSL15 was also expressed in flowers, developing seeds, and in the embryonic scutellar epithelial cells during seed germination. OsYSL15 knockdown seedlings showed severe arrest in germination and early growth and were rescued by high iron supply. These results demonstrate that rice OsYSL15 plays a crucial role in iron homeostasis during the early stages of growth.

Safety of electroconvulsive therapy in psychiatric patients shortly after the occurrence of pulmonary embolism.

We encountered 2 patients with a psychiatric disorder (depression in one and catatonia in one) accompanied by motor inhibition that was complicated by pulmonary embolism (PE). In both cases, the psychiatric disorder was safely resolved with electroconvulsive therapy (ECT) during anticoagulant therapy. The 2 cases direct our attention to at least 3 important points regarding safe administration of ECT shortly after the occurrence of PE, that is, careful evaluation of cardiac function and residual deep vein thrombosis before the start of an ECT course, adjustment of anticoagulants, and prevention of recurrent deep vein thrombosis and PE by methods in addition to anticoagulant therapy (fluid infusion, use of support hose, and timely ECT).

Catatonia complicated by pneumothorax successfully treated with electroconvulsive therapy.

We describe 2 patients with catatonia who developed the complication of pneumothorax, the accumulation of air in the pleural cavity leading to collapse of a lung. Electroconvulsive therapy was safely administered to resolve catatonia, with special attention to managing pneumothorax by insertion of a thoracostomy tube and careful management of ventilation.

Resolution of catatonia by successful seizure induction via electroconvulsive therapy with electrodes applied bilaterally to the parietotemporal region.

Electroconvulsive therapy (ECT) has been shown to be effective in cases of medically intractable mood disorder and schizophrenia. However, some patients receiving ECT have only a short electroencephalographic seizure or no seizure at the maximum stimulus intensity and thus fail to obtain a therapeutic effect. A new treatment option is needed to induce therapeutic seizures in such patients. We report a case of catatonic schizophrenia that was resolved by successful seizure induction by means of ECT with electrodes applied bilaterally to the parietotemporal region after bifrontotemporal ECT failed to induce adequate seizure. We note that parietotemporal ECT can induce therapeutic seizures in patients with a high seizure threshold because more current penetrates the brain due to a decrease in shunted current.

Catatonic stupor superimposed on hereditary spinocerebellar degeneration resolved with electroconvulsive therapy.

We report a 58-year-old woman with catatonic stupor superimposed on hereditary spinocerebellar degeneration (SCD) and psychotic depression. The catatonia and psychotic depression resolved with 11 sessions of electroconvulsive therapy (ECT). Early recognition of catatonia during the course of SCD is important for timely administration of ECT.

Epileptic seizures superimposed on catatonic stupor.

PURPOSE: Some patients with nonconvulsive status epilepticus are known to exhibit catatonic stupor. Thus it is necessary to rule out ictal catatonia by electroencephalography in patients with catatonic stupor. However, few reports are available on epileptic seizures superimposed on catatonic stupor. METHODS: We report three cases of epileptic seizures superimposed on psychiatric catatonic stupor without a prominent predisposing factor, including high fever or encephalitis. None of the patients had a personal or family history of neurologic disease, including epilepsy. RESULTS: In all three patients, catatonic stupor persisted after resolution of the epileptic seizures with administration of phenytoin. In two of the three patients, catatonic stupor resolved with electroconvulsive therapy, which caused no marked adverse effects. CONCLUSIONS: Because it is possible that catatonic stupor itself predisposes patients to the development of epileptic seizures, electroencephalographic examinations in patients with catatonic stupor are indispensable for early recognition not only of nonconvulsive status epilepticus but also of epileptic seizures superimposed on catatonic stupor. Electroconvulsive therapy deserves consideration when catatonic stupor persists after resolution of epileptic seizures.