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1.
J Nippon Med Sch ; 2020 Jan 31.
Artigo em Inglês | MEDLINE | ID: mdl-32009069

RESUMO

BACKGROUND: Most surveillance programs for postoperative infection focus on surgical site infections (SSI). However, remote infections, as postoperative infections, are of emerging clinical importance. We investigated the incidence of both SSI and remote infection following colorectal surgery by performing a subanalysis of a multicenter survey after gastrointestinal surgery. METHODS: From September 2015 to March 2016, 1724 patients underwent colorectal surgery in 28 affiliated institutions in Japan. We retrospectively recorded patients' age, sex, surgical site, surgical approach, wound classification, performance status at discharge, and postoperative infection status. RESULTS: Postoperative infections occurred in 236 (13.7%) patients; 150 and 86 patients underwent colon and rectal surgeries (postoperative infection incidence: 13.7% and 14.8%), respectively. Laparoscopic surgery was associated with a significantly lower incidence of postoperative infection compared with open surgery for both colon and rectal surgery (p < 0.001). Among all patients with postoperative infections, 211 (89.4%) had single infections, and 25 (10.6%) had multiple infections. SSI and remote infection in patients with single postoperative infections occurred in 143 (60.6%) and 68 (28.8%) patients, respectively. The most common multiple postoperative infections were "incisional and organ/space SSIs", and "organ/space SSI and bacteremia of unknown origin", with three cases each. CONCLUSIONS: This study revealed the distribution of the overall prevalence of postoperative infections, including both SSI and remote infections. Considering the substantial influence of remote infections on patients' quality of life and the social burden, prospective periodic surveillance for both SSI and remote infection is necessary for detailed evaluation and prevention.

2.
J Nippon Med Sch ; 2020 Jan 31.
Artigo em Inglês | MEDLINE | ID: mdl-32009071

RESUMO

BackgroundPostoperative infections may be classified as surgical site infections developing within surgical sites or remote infections developing in areas outside the surgical site. Postoperative respiratory tract infections (PRTI) are a type of remote infection, and may be associated with a prolonged hospitalization period and increased medical expenses. The aim of this study is to compare postoperative hospitalization and medical expenses between patients with PRTI and non PRTI after gastrointestinal surgery.MethodsWe retrospectively analyzed data from a multicenter joint study involving multiple centers affiliated to the Japan Society for Surgical Infection. We used a one-to-one matching analysis to evaluate 86 patients who underwent gastrointestinal surgery between March 1, 2014 and February 29, 2016.ResultsThere was a significant increase in the postoperative hospitalization period among patients with PRTI (38.6 days) compared with patients without PRTI (16.1 days). Furthermore, postoperative medical expenses were significantly higher in patients with PRTI (1388.2 USD) than in those without PRTI (629.4 USD).ConclusionsThe hospitalization period and medical expenses are known to increase in patients that develop surgical site infections. Our findings show that these parameters also increase in patients with PRTI following gastrointestinal surgery. However, further studies are needed to confirm these results.

3.
Artigo em Inglês | MEDLINE | ID: mdl-32017303

RESUMO

INTRODUCTION: Pulmonary vein isolation (PVI) and linear ablation with a roof line and bottom line on the left atrial (LA) posterior wall (LAPW) can be achieved with a cryoballoon (CB). This study sought to investigate the long-term durability of these linear lesions. METHODS AND RESULTS: Among 290 persistent patients with atrial fibrillation (AF) who had undergone linear ablation with a CB on the roof and bottom line of the LAPW in addition to the PVI, we analyzed those patients who underwent a re-do AF ablation. Arrhythmia recurrence was confirmed in 70 (24%) out of 290 patients, and 47 (16%) patients underwent re-do sessions. At the beginning of the re-do ablation, we examined the reconnection sites of the linear lesions on the LAPW and PVI. Maintenance of the conduction block on the LAPW roof and bottom lines was observed in 35 out of 47 patients (74.5%), and 16 out of 35 patients (45.7%), respectively. The length of the roof line was significantly shorter in patients with preservation of the conduction block on the LAPW roof than in those without (36.2 ± 6.5 mm vs 41.6 ± 4.7 mm, P = .02). CONCLUSION: Durable lesions could be obtained after linear ablation with the CB for the LAPW roof line, especially in those with a relatively short LAPW roof line. However, patients requiring touch-up ablation with radiofrequency were included, and that was associated with a potential financial implication.

4.
J Gastroenterol ; 2020 Feb 12.
Artigo em Inglês | MEDLINE | ID: mdl-32052185

RESUMO

BACKGROUND: Traditional serrated adenoma (TSA) is the least common type of colorectal serrated polyp, which exhibits considerable morphological and molecular diversity. METHODS: We examined the spectra of alterations in MAPK and WNT pathway genes and their relationship with clinicopathological features in 128 TSAs. RESULTS: Sequencing analyses identified BRAF V600E, BRAF non-V600E, KRAS, and NRAS mutations in 77, 3, 45, and 1 lesion, respectively. Collectively, 124 lesions (97%) had mutations in MAPK pathway genes. Alterations in WNT pathway genes were identified in 107 lesions (84%), including RSPO fusions/overexpression, RNF43 mutations, ZNRF3 mutations, APC mutations, and CTNNB1 mutations in 47, 45, 2, 13, and 2 lesions, respectively. Ten lesions (8%) harbored GNAS mutations. There was significant interdependence between the altered MAPK and WNT pathway genes. RSPO fusions/overexpression was significantly associated with KRAS mutations (31/47, 66%), whereas most RNF43 mutations coexisted with the BRAF V600E mutation (40/45, 89%). Histologically, extensive slit-like serration was more common in lesions with the BRAF V600E mutation (71%) and those with RNF43 mutations (87%). Prominent ectopic crypt formation was more prevalent in lesions with RSPO fusions/overexpression (58%) and those with GNAS mutations (100%). CONCLUSIONS: Our observations indicate that TSAs mostly harbor various combinations of concurrent WNT and MAPK gene alterations. The associations between genetic and morphological features suggest that the histological diversity of TSA reflects the underlying molecular heterogeneity.

5.
Gynecol Oncol ; 2020 Feb 13.
Artigo em Inglês | MEDLINE | ID: mdl-32063274

RESUMO

OBJECTIVE: To compare the efficacy of ascitic fluid cell block (ACB) with that of core needle biopsy (CNB) or the CA125/CEA ratio in diagnosing primary tubo-ovarian cancer in female patients with peritoneal carcinomatosis (PC) with ascites. METHODS: This retrospective study examined female patients with PC with ascites who had available results for ACB, peritoneal tumor CNB, and the CA125/CEA ratio. Several measures of the accuracy of ACB and the CA125/CEA ratio were calculated and compared, with CNB as the reference standard. RESULTS: Of 81 patients with available results, 57 were clinically diagnosed with primary tubo-ovarian cancer. Overall, 52, 47, and 64 patients were diagnosed via CNB, ACB, and CA125/CEA ratio > 25, respectively. CNB and ACB identified the cancer origin in 91.4% and 82.7% cases, respectively. The concordance ratio of the immunohistochemical findings between ACB and CNB was 93.6%. Two patients with inconclusive CNB results were diagnosed with primary tubo-ovarian cancer via ACB. The sensitivity, specificity, positive predictive value, negative predictive value, and positive likelihood ratio were 86.5%, 93.1%, 95.7%, 79.4%, and 12.5, respectively, for ACB and 94.2%, 48.3%, 76.6%, 82.4%, and 1.82, respectively, for CA125/CEA ratio > 25. CONCLUSIONS: ACB is not inferior to CNB in diagnosing primary tubo-ovarian cancer; the two methods complement each other. ACB can substitute CNB in diagnosing primary tubo-ovarian cancer in selected PC patients. ACB is superior to a CA125/CEA ratio of >25 in diagnosing primary tubo-ovarian cancer. ACB is effective, reliable, and convenient for diagnosing primary tubo-ovarian cancer in PC patients with ascites.

6.
Anticancer Res ; 40(1): 169-176, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31892565

RESUMO

BACKGROUND/AIM: Cancer stem cells (CSCs) are considered to be one of the causes of tumor recurrence after chemotherapy. The purpose of our study was to isolate CSCs from human colorectal cancer cell (CRC) lines. MATERIALS AND METHODS: Nine CRC lines were screened based on the expression level of potential CSC markers to identify putative CSCs. Tumor formation capacity in immunodeficient mice was compared with that of their counterparts. Stemness, differentiation potency and sensitivity to 5-fluorouracil (5-FU), in vitro, were also assessed. Microarray analysis was used to characterize the features of the putative CSCs. RESULTS: COLO 201 cells were separated into two populations based on CD44 expression. CD44 positive (CD44+) cells showed significantly higher tumor formation capacity than CD44- cells in immunodeficient mice. CD44+ cells also possessed stemness properties and lower sensitivity to 5-FU in vitro. Moreover, cancer stemness and chemoresistance-related genes were highly up-regulated in CD44+ cells. CONCLUSION: CD44+ COLO 201 cells possessed the features of CSCs; therefore, the present CSC model could serve as a valuable tool to accelerate CSC research.


Assuntos
Receptores de Hialuronatos/metabolismo , Células-Tronco Neoplásicas/metabolismo , Animais , Biomarcadores , Biomarcadores Tumorais , Linhagem Celular Tumoral , Sobrevivência Celular/efeitos dos fármacos , Transformação Celular Neoplásica/genética , Transformação Celular Neoplásica/metabolismo , Neoplasias Colorretais/genética , Neoplasias Colorretais/metabolismo , Modelos Animais de Doenças , Citometria de Fluxo , Fluoruracila/farmacologia , Xenoenxertos , Humanos , Receptores de Hialuronatos/genética , Camundongos
7.
Int Heart J ; 61(1): 121-127, 2020 Jan 31.
Artigo em Inglês | MEDLINE | ID: mdl-31956142

RESUMO

Laserballoon-based pulmonary vein isolation has proven to be safe and effective. However, the influence of the laser energy titration on the lesion formation has never been fully investigated. The aim of this study was to determine the relationship between the delivered laser energy and lesion size, as well as the incidence of steam pop.The whole porcine heart was excised, and the left ventricular myocardium was separated into four specimens. Myocardial specimens were embedded in a warm mattress to keep the myocardial temperature around 37°C. The laserballoon was located so that the surface of the laserballoon was attached to the myocardium. The laser energy was irradiated against the surface of myocardium at 5.5, 8.5, 10.0, and 12.0 W for 3, 5, 10, and 20 seconds. The depth, surface area, and lesion volume were measured using a digital vernier caliper.At constant laser energy and time, the lesion size increased significantly with the increasing energy (P < 0.001) and application duration (P < 0.001). The steam pop was provoked when a 12.0 W laser energy was applied for longer than 16 seconds, and it occurred in 2 out of 8 lesions.The laserballoon demonstrated the ability to create a lesion formation in a dose- and time-dependent manner. Steam pop could be provoked with high-energy irradiation.


Assuntos
Procedimentos Cirúrgicos Cardíacos/instrumentação , Ablação por Cateter/instrumentação , Animais , Suínos , Fatores de Tempo
8.
Gynecol Oncol ; 156(1): 203-210, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31757465

RESUMO

OBJECTIVE: Cervical cancer is the fourth most common cause of cancer-related deaths in Asian women, due to its poor prognosis. This study aimed to decipher genomic alteration profiles of a cohort of Japanese cervical cancer patients to understand why certain patients benefited from molecular targeted therapies and their prognostic significance. METHODS: During 2008-2018, 154 cervical cancer patients underwent a potentially curative resection procedure at the National Cancer Center Hospital. Genomic DNA samples were analyzed using Ion AmpliSeq™ Cancer Hotspot Panel v2. Alterations in the copy number of PIK3CA, ERBB2, PTEN, and STK11 were detected using the TaqMan assay. HPV-positive results were confirmed by genomic testing and in situ hybridization assay. RESULTS: The frequency of genomic alterations in PIK3CA (36%), STK11 (16%), PTEN (11%), TP53 (11%), and KRAS (8%) was >5%. KRAS mutations were preferentially detected in patients with adenocarcinomas, and the frequency of PIK3CA mutations in patients with squamous cell carcinomas was higher than that in patients with other histological cancer types. HPV-positive results were observed in 139/154 (90.3%) patients, and TP53 mutants were detected in HPV-negative specimens. In this study, the overall survival of patients with genomic alterations in STK11 was worse than in patients with wild-type STK11 (hazard ratio = 10.6, P = 0.0079) and TCGA dataset (hazard ratio = 2.46, P = 0.029). CONCLUSIONS: More than one-third of Japanese cervical cancer patients exhibit mutations targeted by molecular targeted therapies. We have proposed the prognostic value of STK11 genomic alterations.

9.
Pacing Clin Electrophysiol ; 43(1): 47-53, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31707738

RESUMO

PURPOSE: The aim of this study was to test regional pharmacological effects of an antiarrhythmic agents to predict ablative effects. BACKGROUND: The vein of Marshall (VOM) providing vascular access to myocardial tissue has been used for ablative purposes using ethanol. METHODS: A total of 35 patients (male 21, 63.2 ± 7.8 years old) were included. A balloon-tipped infusion catheter was inserted into the VOM. Endocardial ultrahigh-resolution mapping was performed along the VOM region to record the change in atrial electrograms (AEs) after VOM injection of cibenzoline of 3.5 mg during sustained atrial fibrillation (AF). Subsequently, ethanol was infused into the VOM and ablative region was mapped. RESULTS: In 17 patients (49 %), cibenzoline reduced AEs amplitude by >50%, all of which had also complete elimination of AEs following ethanol (Group A). In 18 patients (Group B), cibenzoline failed to eliminate AEs; yet, in 13 of 18 AEs were eliminated by ethanol. In the remaining five patients, ethanol did not eliminate AE. CONCLUSIONS: Cibenzoline into the VOM could reliably predicts the results of subsequent ethanol infusion into the VOM using ultrahigh-resolution mapping system, which leads to avoid unnecessary permanent lesion creation by ethanol infusion.

10.
Angle Orthod ; 90(1): 85-91, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31398065

RESUMO

OBJECTIVES: To examine the relationship between mandibular volume and craniofacial morphology in patients with cleft lip and palate using cone beam computed tomography (CBCT) and to compare these findings with control (noncleft) patients undergoing CBCT for other purposes during the deciduous dentition period. MATERIALS AND METHODS: Eighty-four patients were categorized into the unilateral cleft lip and alveolus (UCLA) group (n = 25; mean age, 4.60 ± 0.40 years), unilateral cleft lip and palate (UCLP) group (n = 23; mean age, 4.52 ± 0.39 years), bilateral cleft lip and palate (BCLP) group (n = 22; mean age, 4.54 ± 0.37 years), and control group without cleft (n = 14; mean age, 5.19 ± 0.52 years). Mandibular volume and craniofacial cephalometric measurements were obtained using CBCT. All measurements were assessed by analysis of covariance (ANCOVA) using Bonferroni post hoc pairwise comparison tests. RESULTS: ANCOVA revealed no statistically significant differences in mandibular volume among the groups. SNA° and ANB° were significantly larger in the UCLA and BCLP groups than in the control group. SN-MP° was smallest in the UCLA group. Co-A in the UCLP group was shorter than in the UCLA and BCLP groups. Go-Gn was shortest in the UCLP and BCLP groups compared with the control group. CONCLUSIONS: Three-dimensional evaluation of craniofacial morphology using CBCT can provide valuable information on malocclusion and other dentoskeletal problems among patients with CLP.

11.
Eur J Surg Oncol ; 46(1): 108-114, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31431321

RESUMO

INTRODUCTION: Most patients with colorectal liver metastases, who undergo hepatectomy, experience recurrence. Although the prognosis is poorer for patients with early recurrence (within 6 months after hepatectomy) compared with later recurrence, no biomarker has been identified to predict early recurrence. Minimal residual disease (MRD) in patients who undergo curative surgery is the main cause of recurrence. In cancer patients, long fragment cell-free DNA is detected, and the presence of long fragments of cell-free DNA after surgery can indicate MRD. In this study, we developed a novel biomarker to predict early recurrence of colorectal liver metastases using cell-free DNA. MATERIALS AND METHODS: Forty-one patients with colorectal liver metastases were enrolled. Peripheral blood samples were collected before and at 1 month after hepatectomy. Cell-free DNA was extracted from 1 ml plasma, and the long fragment/ß-globin ratio, which can indicate MRD, was measured by real-time polymerase chain reaction. RESULTS: Three of 21 patients (14.3%) with decreases in the long cell-free DNA fragment/ß-globin ratio after hepatectomy developed early recurrence compared with twelve of 20 patients (60.0%) with an increased ratio (P = 0.002). Patients with a decreased long fragment/ß-globin ratio after hepatectomy had significantly longer recurrence-free survival compared with patients with an increased ratio (366 vs 102 days, P < 0.001). CONCLUSION: The cell-free DNA long fragment/ß-globin ratio may serve as an effective biomarker of early recurrence in patients with colorectal liver metastases, who undergo hepatectomy.

12.
Laryngoscope ; 130(2): 533-540, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30977521

RESUMO

OBJECTIVES/HYPOTHESIS: Individuals with orofacial clefts often experience respiratory problems because of nasopharyngeal abnormalities. Pharyngeal airway morphology is thought to differ among the various cleft types. We measured three-dimensional (3D) airway volume using cone-beam computed tomography (CBCT) analysis to evaluate and compare pharyngeal airways in Japanese preschoolers with and without orofacial clefts. STUDY DESIGN: Retrospective case-control study. METHODS: We enrolled 83 subjects (37 boys, 46 girls; mean age = 4.66 ± 0.56 years) with nonsyndromic orofacial clefts and 16 noncleft healthy subjects (seven boys, nine girls; mean age = 5.30 ± 0.52 years) as controls. The subjects were divided into five groups. Four groups were based on the cleft type: isolated cleft palate, unilateral cleft lip and alveolus), unilateral cleft lip and palate, and bilateral cleft lip and palate. The fifth group included the noncleft controls. All subjects were examined with CBCT, and the 3D airway volume was measured. We analyzed group differences statistically using analysis of covariance with the Bonferroni post hoc pairwise comparison tests for the corrected means. RESULTS: Compared with the noncleft group, each cleft group exhibited significantly decreased total and nasal airway volumes and increased superior and inferior pharyngeal airway volumes. The differences were all statistically significant. CONCLUSIONS: Our findings suggest that anatomical differences exist in pharyngeal airway volumes among various cleft groups and in those without a cleft. LEVEL OF EVIDENCE: 3b Laryngoscope, 130:533-540, 2020.

13.
J Nippon Med Sch ; 86(6): 345-348, 2020 Jan 10.
Artigo em Inglês | MEDLINE | ID: mdl-31204382

RESUMO

Complete surgical excision is the standard treatment for hydrocele of the canal of Nuck. We developed a novel open posterior wall technique for laparoscopic transabdominal pre-peritoneal (TAPP) excision. A 38-year-old woman with a 5-month history of a painless reducible lump in the right groin had recently noticed a slight increase in the size of lump. Computed tomography showed a simple cystic lesion measuring 30 × 27.5 mm. We performed laparoscopic excision of the hydrocele by using the TAPP approach and the open posterior wall technique developed by us. Complete excision of the hydrocele was satisfactorily performed because the region from the external inguinal ring to the periphery could be clearly observed. After an uneventful postoperative course, the patient was discharged. Laparoscopic TAPP excision with open posterior wall technique was useful for complete excision of hydrocele of the canal of Nuck.

14.
Cytopathology ; 31(2): 122-129, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31883401

RESUMO

OBJECTIVE: Cases of pelvic high-grade serous carcinoma (HGSC) with incidentally detected cancer cells (ICCs) in endometrial and/or cervicovaginal cytology have been reported. This study aimed to clarify the incidence and characteristics of pelvic HGSC with ICCs and to determine whether ICCs have a negative prognostic impact. METHODS: Patients with ovarian/tubal/peritoneal HGSC who underwent pre-treatment uterine (endometrial/cervicovaginal) cytology or biopsy between January 2007 and May 2017 were included. We reviewed the frequencies of ICCs and compared the clinicopathological features and survival outcome between the ICC-positive and ICC-negative groups. RESULTS: Of the 160 patients evaluated, 69 (43.2%) had positive ICCs in at least one uterine specimen. There were no significant differences in clinicopathological characteristics, such as age, FIGO stage, serum CA125 level, ascites, and tubal lesion, between the two groups. Moreover, ICCs had no significant survival impact on progression-free survival or overall survival. CONCLUSION: Our study showed a high rate of pelvic HGSC with ICCs in pre-treatment uterine specimens. The ICCs per se had no negative impact on survival outcomes of pelvic HGSC. Furthermore, uterine biopsy and cytology can be useful and less-invasive methods to obtain tubo-ovarian/peritoneal cancer cells before treatment.

15.
Clin Case Rep ; 7(11): 2202-2206, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31788279

RESUMO

As different from radiofrequency current energy, cryofreezing energy is able to provide reversible effects on cardiac tissue, called "cryomapping," which enables us to predict the effects of a subsequent application of ablative energy. Cryomapping is able to delineate the anatomical location of the lower common pathway of atrioventricular nodal reentrant tachycardia.

16.
Anticancer Res ; 39(12): 6851-6857, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31810952

RESUMO

BACKGROUND: This study aimed to determine whether the neutrophil-to-lymphocyte ratio (NLR) reflected poor treatment benefits in patients with tumor proportion score (TPS) ≥50% and who under went first-line pembrolizumab monotherapy. PATIENTS AND METHODS: This study retrospectively analyzed patients with untreated stage III/IV or recurrent non-small cell lung cancer (NSCLC) with TPS ≥50% and who received pembrolizumab monotherapy at two hospitals between February 2017 and April 2019. The NLR was calculated from pre-treatment complete blood counts. RESULTS: A total of 51 previously untreated patients with NSCLC who had TPS ≥50% and who underwent pembrolizumab monotherapy were evaluated. Multivariate analysis revealed that high NLR, Eastern Cooperative Oncology Group performance status (PS) ≥2, stage IV or recurrent cancer, and TPS=50-74% were significantly and independently associated with poor progression-free survival. Moreover, high NLR and PS ≥2 were significantly associated with short overall survival. CONCLUSION: A high pre-treatment NLR was associated with significantly short progression-free and overall survival in previously untreated patients with NSCLC with high expression of programmed cell-death ligand 1 treated with pembrolizumab monotherapy.


Assuntos
Anticorpos Monoclonais Humanizados/administração & dosagem , Antineoplásicos Imunológicos/administração & dosagem , Antígeno B7-H1/metabolismo , Carcinoma Pulmonar de Células não Pequenas/tratamento farmacológico , Neoplasias Pulmonares/tratamento farmacológico , Adulto , Idoso , Idoso de 80 Anos ou mais , Anticorpos Monoclonais Humanizados/uso terapêutico , Antineoplásicos Imunológicos/uso terapêutico , Carcinoma Pulmonar de Células não Pequenas/sangue , Carcinoma Pulmonar de Células não Pequenas/metabolismo , Feminino , Humanos , Contagem de Leucócitos , Neoplasias Pulmonares/sangue , Neoplasias Pulmonares/metabolismo , Contagem de Linfócitos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Análise de Sobrevida , Resultado do Tratamento , Regulação para Cima
18.
Artigo em Inglês | MEDLINE | ID: mdl-31883176

RESUMO

Endometriosis-related cervical neoplasms are rare, and their clinicopathological features and association with human papilloma virus infection are unclear. A postmenopausal woman with recently diagnosed cervical adenocarcinoma was referred to our hospital. After further investigation, we suspected a stage IIB neoplasm that originated from endometriosis of the cervix or left parametrium. A radical hysterectomy was performed, and pathological examination confirmed a stage IIB cervical endometrioid carcinoma arising from the endometriosis in the cervix to the left parametrium that invaded the cervix; human papilloma virus infection of tumor cells was not detected. Endometriosis-related neoplasms can occur in the cervix or parametrium and present as cervical cancer. The neoplasm described here was not associated with human papilloma virus infection.

19.
Int J Clin Oncol ; 2019 Nov 28.
Artigo em Inglês | MEDLINE | ID: mdl-31781993

RESUMO

BACKGROUND AND AIM: Postoperative infectious complications (POI), which can increase length of hospital stay, medical cost, and worsen overall survival, are a concern in minimally invasive colorectal cancer (CRC) surgeries. Recent reports showed that relatively new inflammation-based score, lymphocyte-to-monocyte ratio (LMR) is an independent predictor of long-term outcomes after CRC surgeries. In this study, LMR was evaluated as a predictor of short-term postoperative outcomes. PATIENTS AND METHODS: This was a single-institutional retrospective study of 211 consecutive patients who had undergone laparoscopic CRC surgery with primary tumor resection from January 2014 to August 2015 at Nippon Medical School Chiba Hokusoh Hospital. The patients were divided into two groups (no POI; n = 176 and POI; n = 35). The associations between inflammation-based scores, namely neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and LMR, and the occurrence of POI were investigated. Receiving operator characteristic curve analysis was used to determine the cutoff point of preoperative LMR. RESULTS: Low LMR (cut-off 3.46), long operative time, and smoking were found to be independent predictors of POI in a multivariate analysis (LMR: Odds ratio 5.61, 95% confidence interval 1.98-15.9, P = 0.001). Patients with low LMR also appeared to have more advanced and aggressive tumours. CONCLUSION: This is the first study to report that the lower LMR is a predictive factor of POI after laparoscopic CRC surgery, and it may provide additional information for treatment decisions to prevent POI.

20.
J Nippon Med Sch ; 2019 Nov 28.
Artigo em Inglês | MEDLINE | ID: mdl-31776320

RESUMO

BACKGROUND: We have modified and performed neoadjuvant chemotherapy (NAC) using capecitabine + epirubicin + cyclophosphamide combination therapy ( 'CEX' ) for HER-2 negative breast cancer. In this study, we investigate the outcomes achieved in our institute and report the effectiveness and tolerability of this therapy, retrospectively. METHODS: The patients included in this study had breast cancer that was negative for HER-2 and positive for lymph node metastasis or negative for lymph node metastasis with a tumor diameter of 20 mm or greater without any distant metastasis. Additionally, groups with performance status (PS) 0-1, aged 75 or less, and with an EF > 60% were targeted. Clinical evaluations were made after a total of 4 courses of epirubicin: 80 mg/m2, cyclophosphamide: 500 mg/m2 (administered every 3 weeks) and capecitabine: 1500 mg/m2 (administered for 2 weeks and withdrawn for 1 week). RESULTS: Eighteen patients received treatments between 2009 and 2013. All patients achieved clinical benefits. The clinical response rates (CRR) were 83.3% (15/18) and 50% for clinical complete response (cCR). All patients achieved positive aesthetic outcome with breast-conserving surgery. Those patients had satisfactory outcomes, with pathological complete response (pCR) in 33.3% (triple negative (TN): 6, luminal: 0) and n0 in 68.8% (TN: 8, luminal: 3). All patients with pCR are in a relapse-free survival state and are still under observation. The adverse events were grade 2 or lower for all patients. CONCLUSIONS: This study suggested that 'CEX' therapy as NAC could be an important option for individualized treatment. In particular, it was effective for TN breast cancer.

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