Effects of an elemental diet to reduce adverse events in patients with esophageal cancer receiving docetaxel/cisplatin/5-fluorouracil: a phase III randomized controlled trial-EPOC 2 (JFMC49-1601-C5).

BACKGROUND: Oral mucositis (OM) is an unpleasant adverse event in patients receiving chemotherapy. A prospective feasibility study showed that elemental diet (ED), an oral supplement that does not require digestion, may prevent OM. Based on this, we established a central review system for oral cavity assessment by dental oncology specialists blinded to background data. We used this system to elucidate the preventive effect of an ED against OM in patients with esophageal cancer receiving docetaxel, cisplatin, and 5-fluorouracil (DCF) therapy. PATIENTS AND METHODS: In this phase III, multicenter, parallel-group, controlled trial, patients consuming a normal diet orally were randomly assigned (1 : 1) to receive two cycles of DCF with (group A) or without (group B) an ED (Elental® 160 g/day). We assessed the incidence of grade ≥2 OM evaluated by two reviewers, changes in body weight, prealbumin, C-reactive protein, and DCF completion rate based on ED compliance. RESULTS: Of the 117 patients randomly assigned to treatment, four failed to start treatment and were excluded from the primary analysis; thus, groups A and B comprised 55 and 58 patients, respectively. There were no significant differences in background characteristics. Grade ≥2 OM was observed in eight (15%) and 20 (34%) patients in groups A and B, respectively (P = 0.0141). Changes in body weight and prealbumin during the two DCF cycles were significantly higher in group A than B (P = 0.0022 and 0.0203, respectively). During the first cycle, changes in C-reactive protein were significantly lower in group A than B (P = 0.0338). In group A (receiving ED), the DCF completion rate was 100% in patients with 100% ED compliance and 70% in patients failing ED completion (P = 0.0046). CONCLUSIONS: The study findings demonstrate that an ED can prevent OM in patients with esophageal cancer receiving chemotherapy.

S-1 and oxaliplatin versus tegafur-uracil and leucovorin as post-operative adjuvant chemotherapy in patients with high-risk stage III colon cancer: updated 5-year survival of the phase III ACTS-CC 02 trial.

BACKGROUND: The ACTS-CC 02 trial demonstrated that S-1 plus oxaliplatin (SOX) was not superior to tegafur-uracil and leucovorin (UFT/LV) in terms of disease-free survival (DFS) as adjuvant chemotherapy for high-risk stage III colon cancer (any T, N2, or positive nodes around the origin of the feeding arteries). We now report the final overall survival (OS) and subgroup analysis according to the pathological stage (TNM 7th edition) for treatment efficacy. PATIENTS AND METHODS: Patients who underwent curative resection for pathologically confirmed high-risk stage III colon cancer were randomly assigned to receive either UFT/LV (300 mg/m2 of UFT and 75 mg/day of LV on days 1-28, every 35 days, five cycles) or SOX (100 mg/m2 of oxaliplatin on day 1 and 80 mg/m2/day of S-1 on days 1-14, every 21 days, eight cycles). The primary endpoint was DFS and the patients' data were updated in February 2020. RESULTS: A total of 478 patients in the UFT/LV group and 477 patients in the SOX group were included in the final analysis. With a median follow-up time of 74.3 months, the 5-year DFS rate was 55.2% in the UFT/LV group and 58.1% in the SOX group [stratified hazard ratio (HR) 0.92; 95% confidence interval (CI) 0.76-1.11; P = 0.3973], and the 5-year OS rates were 78.3% and 79.1%, respectively (stratified HR 0.97; 95% CI 0.76-1.24; P = 0.8175). In the subgroup analysis, the 5-year OS rates in patients with T4N2b disease were 51.0% and 64.1% in the UFT/LV and SOX groups, respectively (HR 0.72; 95% CI 0.40-1.31). CONCLUSION: Our final analysis reconfirmed that SOX as adjuvant chemotherapy is not superior to UFT/LV in terms of DFS in patients with high-risk stage III colon cancer. The 5-year OS rate was similar in the UFT/LV and SOX groups.

Dietary arachidonic acid improves age-related excessive enhancement of the stress response.

OBJECTIVE: The aim of this study is to understand whether the responsiveness of the hypothalamic-pituitary-adrenal (HPA) axis to stress increases excessively with aging in senescence-accelerated mice-prone 10 (SAMP10) and to investigate the role of arachidonic acid (ARA) in this process. MATERIALS AND METHODS: The area under the curve of CORT concentration (CORT-AUC), an index of the HPA axis responsiveness to stress, was assessed in SAMP10 subjected to a 30-minute restraint stress up to 120 minutes after the restraint stress onset. Furthermore, the HPA axis responsiveness was evaluated in aged SAMP10 fed 0.4% ARA-containing diet (ARA group) or control diet (CON group) for 4 weeks. Three weeks later, these mice were divided into a group with a 30-minute restraint stress (CON-S or ARA-S group) and a group without restraint stress (CON-NS or ARA-NS group). Hippocampi were collected after stress release and fatty acid and glucocorticoid receptor (GR) protein levels were evaluated in the nucleus and cytosol. RESULTS: The CORT-AUC of aged SAMP10 was 21% significantly higher than that of young SAMP10. In the ARA group, hippocampal ARA was 0.5% significantly higher than that in the CON group. CORT-AUC in the ARA group was 24% significantly lower than that in the CON group. The ratio of GR protein levels in the nucleus and cytosol in the ARA-S group was 1.72 times significantly higher than that in the ARA-NS group but no difference was observed between the CON-S and CON-NS groups. CONCLUSIONS: Dietary ARA seems to suppress age-related excessive enhancement of the HPA axis responsiveness via attenuation of age-related decline in hippocampal GR translocation into the nucleus after stress loading, which may contribute to an improvement of mental health.

Clinical outcome after 36 months of treatment with injections of autologous blood for recurrent dislocation of the temporomandibular joint.

We investigated the prognosis after three years of treatment for recurrent dislocation of the temporomandibular joint with autologous blood given intravenously in 21 patients with a mean (range) age 64 (17-92) years of whom 16 had coexisting systemic disease. The mean (range) follow up from the first injection was 64 (41-99) months. Eighteen patients had no recurrence during the first 36 months after their first injection, which showed that this minimally-invasive treatment was effective, particularly for those who had conditions that made a mouthpiece or operation unsuitable.

Randomized phase III study of bevacizumab plus FOLFIRI and bevacizumab plus mFOLFOX6 as first-line treatment for patients with metastatic colorectal cancer (WJOG4407G).

BACKGROUND: FOLFIRI and FOLFOX have shown equivalent efficacy for metastatic colorectal cancer (mCRC), but their comparative effectiveness is unknown when combined with bevacizumab. PATIENTS AND METHODS: WJOG4407G was a randomized, open-label, phase III trial conducted in Japan. Patients with previously untreated mCRC were randomized 1:1 to receive either FOLFIRI plus bevacizumab (FOLFIRI + Bev) or mFOLFOX6 plus bevacizumab (mFOLFOX6 + Bev), stratified by institution, adjuvant chemotherapy, and liver-limited disease. The primary end point was non-inferiority of FOLFIRI + Bev to mFOLFOX6 + Bev in progression-free survival (PFS), with an expected hazard ratio (HR) of 0.9 and non-inferiority margin of 1.25 (power 0.85, one-sided α-error 0.025). The secondary end points were response rate (RR), overall survival (OS), safety, and quality of life (QoL) during 18 months. This trial is registered to the University Hospital Medical Information Network, number UMIN000001396. RESULTS: Among 402 patients enrolled from September 2008 to January 2012, 395 patients were eligible for efficacy analysis. The median PFS for FOLFIRI + Bev (n = 197) and mFOLFOX6 + Bev (n = 198) were 12.1 and 10.7 months, respectively [HR, 0.905; 95% confidence interval (CI) 0.723-1.133; P = 0.003 for non-inferiority]. The median OS for FOLFIRI + Bev and mFOLFOX6 + Bev were 31.4 and 30.1 months, respectively (HR, 0.990; 95% CI 0.785-1.249). The best overall RRs were 64% for FOLFIRI + Bev and 62% for mFOLFOX6 + Bev. The common grade 3 or higher adverse events were leukopenia (11% in FOLFIRI + Bev/5% in mFOLFOX6 + Bev), neutropenia (46%/35%), diarrhea (9%/5%), febrile neutropenia (5%/2%), peripheral neuropathy (0%/22%), and venous thromboembolism (6%/2%). The QoL assessed by FACT-C (TOI-PFC) and FACT/GOG-Ntx was favorable for FOLFIRI + Bev during 18 months. CONCLUSION: FOLFIRI plus bevacizumab was non-inferior for PFS, compared with mFOLFOX6 plus bevacizumab, as the first-line systemic treatment for mCRC. CLINICAL TRIALS NUMBER: UMIN000001396.

Glue embolization for gastroduodenal ulcer bleeding: contribution to hemodynamics and healing process.

BACKGROUND: Although the morbidity of bowel ischemic events after glue embolization has been suggested, a causal relationship between glue and ischemia has not been clearly established. PURPOSE: To evaluate the efficiency and safety of transcatheter arterial embolization with n-butyl cyanoacrylate (NBCA-TAE) for upper gastrointestinal hemorrhage (GIH). MATERIAL AND METHODS: Between October 2006 and October 2012, 21 patients with upper GIH underwent NBCA-TAE, and endoscopic data were obtained within 30 days of follow-up. Shock index prior to and immediately after NBCA-TAE were compared to determine changes in hemodynamics. Days to Forrest type III, as assessed by follow-up endoscopy, was used as an indicator of the healing process. Other clinical outcomes included days for starting ingestion and for hospital discharge. RESULTS: Sixteen gastric and five duodenal ulcers, classified into Forrest type I, were treated. Immediate hemostasis was achieved in all the patients, and no re-bleeding occurred within the follow-up period. Shock index significantly (P < 0.001) improved from before (0.99 ± 0.076) to immediately after NBCA-TAE (0.67 ± 0.038). Sequential mucosal healing processes were observed in all the patients, and the number of days to Forrest type III was 9.6 ± 7.1. The number of days for starting ingestion and hospital discharge was 9.0 ± 4.5 and 15 ± 7.7 days, respectively. CONCLUSION: NBCA-TAE is an effective and safe method for the control of nonvariceal upper GIH, in terms of contribution to hemodynamics and healing process of the gastroduodenal mucosa.

Prospective evaluation of corrected QT intervals and arrhythmias after exposure to epirubicin, cyclophosphamide, and 5-fluorouracil in women with breast cancer.

BACKGROUND: Corrected QT (QTc) interval prolongation can induce fatal arrhythmias such as torsade de pointes. PATIENTS AND METHODS: To assess the characteristics of QTc intervals and arrhythmias in women with early breast cancer who received FEC100 adjuvant chemotherapy, electrocardiograms (ECGs) were recorded before and after each chemotherapy. Associations between QTc interval prolongation and single nucleotide polymorphisms (SNPs) of potassium channel genes were also investigated. RESULTS: A total of 131 ECG records were obtained in 34 patients who received 153 cycles of FEC100. QTc intervals could be measured in 127 records. There was a significant trend toward QTc interval prolongation after each treatment, persisting through four cycles of chemotherapy (P < 0.001). Median QTc interval prolongations were 13, 11, 18, and 14 ms in the first through fourth cycles of chemotherapy, respectively. QTc intervals differed significantly between cycles 1 and 4 before treatment as well as after treatment (P < 0.05). A single supraventricular premature contraction was noted in 3 (2.3%) of the 131 cycles in 2 (5.9%) of the 34 patients. There was no significant association between QTc interval prolongation and SNPs of potassium channel genes. CONCLUSION: This prospective study confirmed that FEC100 is associated with significant QTc interval prolongation in women with early breast cancer.

Activity-dependent remodeling of chondroitin sulfate proteoglycans extracellular matrix in the hypothalamo-neurohypophysial system.

The hypothalamo-neurohypophysial system (HNS) consisting of arginine vasopressin (AVP) and oxytocin (OXT) magnocellular neurons shows the structural plasticity including the rearrangement of synapses, dendrites, and neurovascular contacts during chronic physiological stimulation. In this study, we examined the remodeling of chondroitin sulfate proteoglycans (CSPGs), main extracellular matrix (ECM), in the HNS after salt loading known as a chronic stimulation to cause the structural plasticity. In the supraoptic nucleus (SON), confocal microscopic observation revealed that the immunoreactivity of 6B4 proteoglycans (PG) was observed mainly at AVP-positive magnocellular neurons but that of neurocan was seen chiefly at OXT-positive magnocellular neurons. The immunoreactivity of phosphacan and aggrecan was seen at both AVP- and OXT-positive magnocellular neurons. Electron microscopic observation further showed that the immunoreactivity of phosphacan and neurocan was observed at astrocytic processes to surround somata, dendrites, and terminals, but not synaptic junctions. In the neurohypophysis (NH), the immunoreactivity of phosphacan, 6B4 PGs, and neurocan was observed at AVP-positive magnocellular terminals, but the reactivity of Wisteria floribunda agglutinin lectin was seen at OXT-positive ones. The immunoreactivity of versican was found at microvessel and that of aggrecan was not detected in the NH. Quantitative morphometrical analysis showed that the chronic physiological stimulation by 7-day salt loading decreased the level of 6B4 PGs in the SON and the level of phosphacan, 6B4 PGs, and neurocan in the NH. These results suggest that the extracellular microenvironment of CSPGs is different between AVP and OXT magnocellular neurons and activity-dependent remodeling of CSPGs could be involved in the structural plasticity of the HNS.

Effects of socioeconomic factors and cancer survivors' worries on their quality of life (QOL) in Japan.

Effects of socioeconomic factors and cancer survivors' worries on their quality of life (QOL) were investigated. In 2002, Japanese national survey was performed to assess distress among cancer patients using a semi-structured questionnaire (http://www.scchr.jp/yorozu/pdf/taiken_koe_eng.pdf). We investigated relationships between patients' distress and their QOL measured by European Organization for Research and Treatment of Cancer Core Questionnaire (EORTC QLQ-C30) and Functional Assessment of Chronic Illness Therapy--12-item Spiritual Well-Being Scale (FACIT-Sp), using a covariance structure analysis and multivariate regression analysis. A total of 130 outpatients (male: 42%; average age: 59 years; performance status rating 0-2:89%; breast/lung/gastrointestinal cancer: 38/22/21%) answered the questionnaires. A covariance structure analysis extracted latent variables, which were named socioeconomic distress and cancer worries, using a model that sufficiently represented the observed data (Goodness of fit index = 0.833). Regression analysis demonstrated that higher family income significantly correlated with better Global health status/QOL (p = 0.003) but that losing a job negatively correlated with all of the scales on functioning in the QLQ-C30 (p < 0.05) and spiritual well-being (p < 0.05). Patients' QOL was also affected by physical worries and spiritual issues in terms of emotional, cognitive, and social functioning. In conclusion, cancer survivors' QOL was doubly affected by socioeconomic distress and cancer worries. In the former, lower family income and losing employment by experiencing cancer had a negative impact on patients' QOL. As to the latter, physical worries and spiritual issues also affected patients' QOL.

Estimulación epidural de la médula espinal para eltratamiento del síndrome de piernas inquietasdolorosas / Epidural spinal cord stimulation for the treatment of painful legs and moving toes syndrome

Un caso de síndrome de piernas inquietas dolorosas en un varón de 51 años fue tratado con éxito mediante estimulación epidural de la médula espinal. El paciente había recibido tratamiento previo con distintas medicaciones, bloqueo epidural, estimulación nerviosa transcutánea y bloqueo simpático lumbar, con ningún efecto o sólo un efecto transitorio. La estimulación epidural de la médula espinal se realizó mediante la colocación percutánea de electrodos epidurales conectados a una extensión percutánea durante un período de prueba de 2 semanas y, posteriormente, a un dispositivo permanente (ITREL). El dolor y los movimientos involuntarios desaparecieron casi por completo durante la estimulación y el efecto siguió siendo evidente 6 meses después (AU)

Epidural spinal cord stimulation for the treatment of painful legs and moving toes syndrome.

A case of 51-year-old male with painful legs and moving toes syndrome was successfully treated with epidural spinal cord stimulation. He was previously treated with varieties of medication, epidural block, transcutaneous nerve stimulation, lumbar sympathetic block, with no or only a transient effect. Epidural spinal cord stimulation was applied by means of percutaneously inserted epidural electrodes connected to a percutaneous extension for 2-week test stimulation period and later to a permanent device (ITREL). Pain and involuntary movement were relieved almost completely during the stimulation and the effect was still evident 6 months later.

Effects of absorbed components of saiboku-to on the release of leukotrienes from polymorphonuclear leukocytes of patients with bronchial asthma.

Previous studies confirmed the efficacy of the Chinese herbal remedy Saiboku-to in patients with steroid-dependent asthma. We studied 8 phenolic compounds, isolated from the urine of patients receiving Saiboku-to, with respect to their effects on leukotriene (LT) release by polymorphonuclear leukocytes (PMN) obtained from 6 patients with atopic asthma and 8 healthy subjects. The compounds (0.01-10 micrograms/ml) were incubated with Ca2+ ionophore (A23187)-stimulated PMN, and concentrations of leukotriene B4 (LTB4) and leukotriene C4 (LTC4) in the supernatant were measured by EIA. Each compound suppressed the release of LTB4 and LTC4 by PMN obtained from healthy and asthmatic subjects. In particular, baicalein and magnolol were 5-10 times more potent than azelastine, an antiallergic drug, and significantly suppressed LTC4 release by PMN obtained from asthmatic patients, as compared with healthy subjects. Suppression of LTC4 release by these compounds may play an important role in the clinical efficacy of Saiboku-to.

How events are reviewed matters: effects of varied focus on eyewitness suggestibility.

Witnesses to a crime or an accident perceive that event only once, but they are likely to think or talk about it multiple times. The way in which they review the event may affect their later memory. In particular, some types of review may increase suggestibility if the witness has been exposed to postevent misleading information. In Experiment 1, participants viewed a videotaped crime and then received false suggestions about the event. We found that participants who were then asked to focus on specific details when reviewing the event were more suggestible on a later source memory test than participants asked to review the main points. The findings of Experiment 2 suggest that this effect was not due to a criterion shift at test. These findings indicate that the type of rehearsal engaged in after witnessing an event can have important consequences for memory and, in particular, suggestibility.

Inhibitory effects of lignans and flavonoids in saiboku-to, a herbal medicine for bronchial asthma, on the release of leukotrienes from human polymorphonuclear leukocytes.

To identify the anti-allergic components contained in Saiboku-To, a herbal medicine for the treatment of bronchial asthma, we studied the effects of eight phenolic compounds, which have been identified as the major human metabolites of Saiboku-To, and three triterpenoids contained in Saiboku-To on the release of leukotriene (LT) from human polymorphonuclear leukocytes (PMLs) stimulated with Ca(2+)-ionophore A23,187. All phenolic compounds exhibited dose-dependent suppression on release of both LTB4 and LTC4, while triterpenoids did not show any effects, except for glycyrrhetinic acid, which selectively inhibited LTC4-release. The five phenolic compounds, magnolol, dihydroxydihydromagnolol, baicalein, medicarpine and davidigenin, were found to exert a marked inhibition on LTB4- and LTC4-release with IC50 values of 0.7-15.3 microM. The results suggest that the phenolic compounds contribute to the anti-allergic effects of Saiboku-To through suppression of LT-release from PMLs.

A Clostridium perfringens hem gene cluster contains a cysG(B) homologue that is involved in cobalamin biosynthesis.

The hem gene cluster, which consists of hemA, cysG(B), hemC, hemD, hemB, and hemL genes, and encodes enzymes involved in the biosynthetic pathway from glutamyl-tRNA to uroporphyrinogen III, has been identified by the cloning and sequencing of two overlapping DNA fragments from Clostridium perfringens NCTC8237. The deduced amino acid sequence of the N-terminal region of C. perfringens HemD is homologous to those reported for the C-terminal region of Salmonella typhimurium CysG and Clostridium josui HemD. C. perfringens CysG(B) is a predicted 220-residue protein which shows homology to the N-terminal region of S. typhimurium CysG. Disruption of the cysG(B) gene in C. perfringens strain 13 by homologous recombination reduced cobalamin (vitamin B12) levels by a factor of 200. When grown in vitamin B12-deficient medium, the mutant strain showed a four-fold increase in its doubling time compared with that of the wild-type strain, and this effect was counteracted by supplementing the medium with vitamin B12. These results suggest that C. perfringens CysG(B) is involved in the chelation of cobalt to precorrin II as suggested for the CysG(B) domain of S. typhimurium CysG, enabling the synthesis of cobalamin.

[Low-dose CDDP and continuous 5-FU treatment of advanced gastric cancer with peritoneal dissemination: a case with long disease-free survival].

The patient was diagnosed to have gastric cancer (T3 N3 M0 P3, Stage IV b). We conducted LcFP therapy. CDDP, 7 mg/m2/day, day 1-5 i.v. drip for 2 hours, and 5-FU, 170 mg/m2/day, day 1-7, i.v. continuously for 24 hours. After 3 courses (one course: 4 LcFPs followed by one rest week), down staging (T3 N2 M0 P1. Stage IV a) and improvement of performance status were obtained, and then surgical resection was undertaken. After operation one course of LcFP therapy served as adjuvant chemotherapy. The patient has survived over one year and 8 months to date in a tumor-free condition. LcFP therapy promises to be useful in the clinical management of advanced gastric cancer.

[The evaluation of weekly hepatic arterial infusion of high-dose 5-FU for liver metastases from colorectal cancer].

A study was conducted on weekly infusion of high-dose 5-FU through the hepatic artery for liver metastases from colorectal cancer. In the evaluation of 38 cases, no CR and 16 PR were to control the extrahepatic metastases is a subject for forthcoming study.

New ferromagnetic bone cement for local hyperthermia.

We have developed a ferromagnetic bone cement as a thermoseed to generate heat by hysteresis loss under an alternate magnetic field. This material resembles bioactive bone cement in composition, with a portion of the bioactive glass ceramic component replaced by magnetite (Fe3O4) powder. The temperature of this thermoseed rises in proportion to the weight ratio of magnetite powder, the volume of the thermoseed, and the intensity of the magnetic field. The heat-generating ability of this thermoseed implanted into rabbit and human cadaver tibiae was investigated by applying a magnetic field with a maximum of 300 Oe and 100 kHz. In this system, it is very easy to increase the temperature of the thermoseed in bone beyond 50 degrees C by adjusting the above-mentioned control factors. When the temperature of the thermoseed in rabbit tibiae was maintained at 50 to 60 degrees C, the temperature at the interface between the bone and muscle (cortical surface) surrounding the material rose to 43 to 45 degrees C; but at a 10-mm distance from the thermoseed in the medullary canal, the temperature did not exceed 40 degrees C. These results demonstrate that ferromagnetic bone cement may be applicable for the hyperthermic treatment of bone tumors.

Stool appearance in intussusception: assessing the value of the term "currant jelly".

This study surveyed the stool appearance descriptions of 107 inpatient children with intussusception. Fifty-six patients presented with grossly bloody stools (passed spontaneously), 10 of which were determined on chart review to resemble currant jelly. Of the 51 patients without grossly bloody spontaneously passed stools, 35 patients had rectal examination results charted. Eight of these children had grossly bloody stools noted on rectal examination, 4 of which were determined on chart review to resemble currant jelly. While most of the grossly bloody stools were not consistent with pure currant jelly, the most common terms used in describing the grossly bloody stools were "bloody," "mucus," "red," and "diarrhea." Since stools truly resembling currant jelly account for a minority of the grossly bloody stools in intussusception, the term "currant jelly stools" should be assessed in the teaching of intussusception. Generic terms such as blood, mucus, burgundy, red, etc, are more objective and sensitive at identifying cases of intussusception. Junior physicians who are taught the classic presentation of intussusception with currant jelly stool should also be taught that intussusception should be considered in the differential diagnosis of children passing any type of bloody stool. As a result, physicians with limited experience will be more likely to appropriately consider the diagnosis of intussusception, permitting a more timely diagnosis and a better outcome.