Preoperative Prognostic Nutritional Index Predicts Long-Term Surgical Outcomes in Patients with Esophageal Squamous Cell Carcinoma.

BACKGROUND: The purpose of the present study is to investigate the utility of prognostic nutritional index (PNI) as a simple and readily available marker in esophageal squamous cell carcinoma (ESCC). METHODS: We retrospectively analyzed 169 patients who underwent potentially curative esophagectomy, for histologically verified ESCC. We decided to set the optimal cutoff value for preoperative PNI levels at 49.2, based on the cancer-specific survival (CSS) and the overall survival (OS) by receiver operating characteristic curve analysis. RESULTS: Multivariate logistic regression analysis identified that TNM pStage III [hazard ratio (HR) 3.261, p < 0.0001] and PNI < 49.2 (HR 3.887, p < 0.0001) were confirmed as independent poor predictive factors for CSS, and age >70 (HR 2.024, p < 0.0042), TNM pStage III (HR 2.510, p = 0.0002), and PNI < 49.2 (HR 2.248, p = 0.0013) were confirmed as independent poor predictive factors for OS. In non-elderly patients, TNM pStage III (CSS; HR 3.488, p < 0.0001, OS; HR 2.615, p = 0.0007) and PNI < 49.2 (CSS; HR 3.849, p < 0.0001, OS; HR 2.275, p = 0.001) were confirmed as independent poor predictive factors for CSS, and OS when multivariate logistic regression analysis was applied. But in elderly patients, univariate analyses demonstrated that the TNM pStage III was the only significant risk factor for CSS (HR 3.701, p = 0.0057) and OS (HR 1.974, p = 0.0224). CONCLUSIONS: The PNI was a significant and independent predictor of CSS and OS of ESCC patients after curative esophagectomy. The PNI was cost-effective and readily available, and it could act as a marker of survival.

Complete abdominal wound and anastomotic leak with diffuse peritonitis closure achieved by an abdominal vacuum sealing drainage in a critical ill patient: a case report.

BACKGROUND: Negative pressure wound therapy (NPWT) is a widely accepted technique to treat local infectious wounds of the skin, subcutaneous tissue, fascia, or muscle. Recently, several reports describing the efficacy of NPWT for various types of fistulas and anastomotic leaks have been published. We herein describe a patient with an open abdominal wound due to colonic anastomotic leakage and diffuse peritonitis, in whom abdominal vacuum sealing (AVS) as a modified NPWT was useful for the management of this complex wound. CASE PRESENTATION: A 32-year-old man was admitted to our hospital with late presenting traumatic diaphragmatic hernia and strangulated ileum complicated by necrosis of the ileum and transverse colon. He had a history of cervical spinal cord injury due to suicide attempt 14 years earlier and, as a result of cervical spinal cord injury, he was paralyzed in the lower body. The patient underwent an urgent hernia repair and bowel resection. Postoperatively, he developed severe septic shock. On postoperative day (POD) 6, wound dehiscence due to colonic anastomotic leakage with diffuse peritonitis was diagnosed, but he was unable to undergo re-operation because of refractory severe septic shock combined with neurogenic shock due to the cervical cord injury. The patient was treated with AVS therapy. He gradually recovered from septic shock, and the anastomotic leakage healed after a 2-month period. The wound dehiscence was also reduced. The patient resumed oral intake on POD 112 and was discharged on POD 190. CONCLUSIONS: Although surgical repair would be the best method for the treatment of diffuse peritonitis due to gastrointestinal perforation or anastomotic leakage, our case suggests that AVS with 'conventional' drainage is a treatment of choice for open abdominal wounds even in the presence of diffuse peritonitis caused by intestinal anastomotic leakage, especially in patients with poor general medical condition.

[Prolonged Survival Following Chemotherapy in Bone Marrow Carcinomatosis Due to Esophagogastric Junctional Carcinoma - A Case Report].

A 60s-year-old Japanese male underwent curative resection for an advanced adenocarcinoma of the esophagogastric junction(Stage III C), followed by adjuvant chemotherapy.Twenty -one months later, he was admitted to our hospital with a complaint of marked decline in activities of daily living(ADL).The patient was diagnosed with pancytopenia, disseminated intravascular coagulation(DIC), multiple lymph node and bone metastases, and bone marrow carcinomatosis.After completing a sufficient informed consent process, he received chemotherapy along with blood transfusion, and then DIC, pancytopenia, and ADL of the patient improved.However, the lack of response of pancytopenia and DIC to transfusion relapsed and his ADL worsened after the second course of chemotherapy.It was difficult to administer additional chemotherapy in the patient and he died 24 months after surgery.There is no established treatment for disseminated carcinomatosis of the bone marrow, and the prognosis of these patients without treatment is reported to be only one month.Our case with prolonged survival following chemotherapy and blood transfusion may support the clinical usefulness of chemotherapy for bone marrow carcinomatosis from esophagogastric junctional carcinoma.

Comparison of energy metabolism and nutritional status of hospitalized patients with Crohn's disease and those with ulcerative colitis.

This study aimed to compare the nutritional status and energy expenditure of hospitalized patients with Crohn's disease (CD) and those with ulcerative colitis (UC). Twenty-two hospitalized patients with CD and 18 patients with UC were enrolled in this study. We analyzed nutritional status upon admission by using nutritional screening tools including subjective global assessment, malnutrition universal screening tool, and laboratory tests. We measured resting energy expenditure (mREE) of the patients with indirect calorimetry and predicted resting energy expenditure (pREE) was calculated by using the Harris-Benedict equation. Results presented here indicate no significant difference in nutritional parameters and energy metabolism between CD and UC patients. In UC patients, a significant correlation was observed between mREE/body weight and disease activity detected by the Lichtiger and Seo indices. However, there was no correlation between mREE/body weight and Crohn's disease activity index in CD patients. Inflammatory cytokine interleukin-6 levels correlated with mREE/pREE in CD and UC patients while tumor necrosis factor-α was not. In conclusion, energy expenditure significantly correlated with disease activity in UC patients but not in CD patients. These results indicate that establishing daily energy requirements based on disease activity of UC is imperative for improving the nutritional status of patients.

[Search for Factors Related to Vascular Pain Expression upon Administration of Oxaliplatin into a Peripheral Vein].

We investigated the relationship between vascular pain and various characteristics (age, sex, cancer stage, performance status [PS], height, weight, body mass index [BMI], body surface area, oxaliplatin dose, and presence and absence of the initial administration of dexamethasone) in colorectal cancer patients who were administered initial doses of oxaliplatin intravenously. The study population included 29 patients treated at Higashi Totsuka Memorial Hospital between June 2010 and April 2014. One-way analysis of variance showed that vascular pain was significantly associated with weight (p=0.015), body surface area (p=0.013), and oxaliplatin doses (p=0.0026), where the significance level was p=0.05. Logistic regression analysis and the likelihood ratio test demonstrated that the likelihood of vascular pain increased with the increase in the oxaliplatin dose. According to the cut-off value of vascular pain determined using the receiver operating characteristic (ROC) analysis, a single dose of oxaliplatin was determined to be 175 mg or more. According to the cut-off value established using the ROC analysis, a single dose of oxaliplatin at which vascular pain is expressed was determined to be 175 mg or more. At this dose, 13 patients complained of vascular pain and 8 did not. At doses less than 175 mg, none of the 8 patients complained of vascular pain. These results suggest that lowering the diluted concentration and reducing the infusion rate of intravenously administered oxaliplatin may reduce vascular pain.

An Imaging Feature Predicts Efficacy of Atezolizumab Plus Bevacizumab in Unresectable Hepatocellular Carcinoma.

BACKGROUND/AIM: Systemic chemotherapy with atezolizumab plus bevacizumab is approved for unresectable hepatocellular carcinoma (HCC). It is necessary to identify probable predictive biomarkers for chemotherapies. HCC with rim arterial-phase enhancement (APHE) has been linked to aggressive tumor activity. PATIENTS AND METHODS: We studied the efficacy of atezolizumab plus bevacizumab for HCC using computed tomography (CT) or magnetic resonance imaging (MRI) imaging features. In total, 51 HCC patients who underwent CT or MRI were classified by the feature of rim APHE. RESULTS: Clinical responses to chemotherapy were evaluated, and among those who received atezolizumab plus bevacizumab, there were 10 (19.6%) patients with rim APHE and 41 (80.4%) patients without rim APHE. We found that patients with rim APHE had a better response than those without rim APHE, and patients with rim APHE had longer median progression-free survival compared with those without rim APHE (p=0.026). Furthermore, liver tumor biopsy showed that HCC with rim APHE had a higher proportion of CD8+ tumor-infiltrating lymphocytes (p<0.01). CONCLUSION: Rim APHE in CT/MRI imaging might be a noninvasive biomarker for predicting response to atezolizumab plus bevacizumab.

Tumor­infiltrating CD8+ T cells as a biomarker for chemotherapy efficacy in unresectable hepatocellular carcinoma.

Atezolizumab plus bevacizumab and lenvatinib are approved frontline therapies for advanced hepatocellular carcinoma (HCC). Patients with advanced HCC continue to have a poor prognosis despite these therapeutic choices. Previous studies have reported CD8+ tumor-infiltrating lymphocytes (TILs) as a biomarker to predict responsiveness to systemic chemotherapy. The present study investigated whether evaluating CD8+ TILs by immunohistochemistry staining of liver tumor biopsy tissues could help predict the response of patients with HCC to atezolizumab plus bevacizumab and lenvatinib. In total, 39 patients with HCC who underwent liver tumor biopsy were classified into high and low CD8+ TILs groups and were then divided by therapy type. The clinical responses to treatment in both groups were evaluated for each therapy. There were 12 patients with high-level CD8+ TILs and 12 patients with low-level CD8+ TILs among those who received atezolizumab plus bevacizumab. An improved response rate was observed in the high-level group compared with the low-level group. The high-level CD8+ TILs group had a significantly longer median progression-free survival compared with the low-level group. Among the patients with HCC who received lenvatinib, five had high-level CD8+ TILs and 10 had low-level CD8+ TILs. There were no differences in response rate or progression-free survival between these groups. Although the present study included only a limited number of patients, the findings suggested that CD8+ TILs could be a biomarker for predicting response to systemic chemotherapy in HCC.

Minocycline-Induced Hyperpigmentation: Importance of Early Diagnosis.

A 75-year-old woman on hemodialysis for end-stage renal failure due to polycystic kidney disease developed dark spots on her limbs. She had been treated for extended spectrum beta-lactamase-producing Escherichia coli bacteremia by a rectovaginal fistula and was on long-term oral minocycline (cumulative dose 45 g). Physical examination revealed dark patches on her forearms and lower legs but no trunk hyperpigmentation or visual impairment. Blood tests were normal. Skin biopsy confirmed minocycline-induced hyperpigmentation. Minocycline-induced pigmentation is categorized into types I-IV, each with unique clinical and histopathological features. Types I and II are reversible upon discontinuing minocycline, whereas types III and IV are permanent. The patient was diagnosed with type II pigmentation, generally occurring with a cumulative dose exceeding 70-100 g; however, her lower dose (45 g) led to pigmentation, possibly influenced by her vitamin D deficiency. Clinicians should evaluate the antimicrobial indication and treatment period, considering not only the benefits but also the side effects and antimicrobial resistance. If minocycline is used, attention should be paid to minocycline-induced hyperpigmentation, and this possibility should be communicated to patients to enable early detection.

Influence of Hospital Formularies on Outpatient Prescribing Practices: Analysis of the Introduction of a Local Formulary: A Single-Center, 2-Year Follow-Up, Retrospective Cohort Study of a Local Formulary in Japan.

PURPOSE: The impact of a hospital formulary was evaluated to provide a guide for the establishment of local formularies to optimize patient care and healthcare costs. METHODS: A formulary was introduced by formulary pharmacists of the Toda Medical Group for suggesting recommended medicines to physicians based on the medication history. Patients who were hospitalized in the rehabilitation ward of the Niiza Hospital and prescribed medicines according to the formulary introduced between April 2017 and March 2018 were included and followed-up for six months. RESULTS: Of the 183 patients screened, 154 patients were enrolled as the formulary's introduction patients (76 males/78 females, median age 78 years); 92% of these patients received formulary-proposed prescriptions at the specified timepoints; and 19 patients re-consulted at the Niiza Hospital after discharge and continued the same formulary medicines. The proposed acceptance rate by physicians was 100%. Most changes suggested introduced generic formulations. The doses were equivalent for all pharmacological classes with the exception of medicines that interfere with the renin-angiotensin system, which fell from 10.7 to 7.2 mg (P< .0001). Overall daily medication costs fell at discharge compared to admission (38.5 vs. 94.6 yen per patient, respectively, P< .0001). This was valid for all pharmacological classes except for calcium channel blockers. CONCLUSION: Hospital formulary-prescribed medications continued after discharge and promoted significant decreases in costs associated with outpatient prescriptions. Introducing a hospital formulary provides a basis for the introduction of local formularies and contributes to the reduction of local healthcare costs.

A novel fast kilovoltage switching dual-energy computed tomography technique with deep learning: Utility for non-invasive assessments of liver fibrosis.

PURPOSE: To investigate whether the iodine density of liver parenchyma in the equilibrium phase and extracellular volume fraction (ECV) measured by deep learning-based spectral computed tomography (CT) can enable noninvasive liver fibrosis staging. METHOD: We retrospectively analyzed 63 patients who underwent dynamic CT using deep learning-based spectral CT before a hepatectomy or liver transplantation. The iodine densities of the liver parenchyma (I-liver) and abdominal aorta (I-aorta) were independently measured by two radiologists using iodine density images at the equilibrium phase. The iodine-density ratio (I-ratio: I-liver/I-aorta) and CT-ECV were calculated. Spearman's rank correlation analysis was used to evaluate the relationship between the I-ratio or CT-ECV and liver fibrosis stage, and receiver operating characteristic (ROC) analysis was used to evaluate the diagnostic performances of the I-ratio and CT-ECV. RESULTS: The I-ratio and CT-ECV showed significant positive correlations with liver fibrosis stage (ρ = 0.648, p < 0.0001 and ρ = 0.723, p < 0.0001, respectively). The areas under the ROC curve for the CT-ECV were 0.882 (F0 vs ≥ F1), 0.873 (≤F1 vs ≥ F2), 0.848 (≤F2 vs ≥ F3), and 0.891 (≤F3 vs F4). CONCLUSIONS: Deep learning-based spectral CT may be useful for noninvasive assessments of liver fibrosis.

High-risk HPV-related Squamous Cell Carcinoma in the Conjunctiva and Lacrimal sac: Clinicopathologic Characteristics and Diagnostic Utility of p16 and Rb Immunohistochemistry.

High-risk human papillomavirus (HPV) infection in conjunctival and lacrimal sac squamous cell carcinomas (SCCs) has been sporadically reported; however, its prevalence, clinicopathologic significance and surrogate markers have not been fully elucidated. Here, we attempted to clarify these questions in Japanese patients with conjunctiva and lacrimal sac SCCs. We retrospectively collected 51 conjunctival SCC and 7 lacrimal sac SCC samples and analyzed them for (1) transcriptionally active high-risk HPV infection using messenger RNA in situ hybridization and (2) protein expressions of p16 and Rb using immunohistochemistry (IHC). Among a total of 58 cases, 25 (43.1%) and 16 (27.6%) tumors were positive for p16-IHC and HPV in situ hybridization, respectively. Ten (19.6%) of the 51 conjunctival SCCs, especially in the palpebral conjunctiva, and 6 (85.7%) of the 7 lacrimal sac SCCs were positive for high-risk HPV. High-risk HPV infection was significantly associated with younger patients, nonkeratinizing SCC histology, p16-positivity and partial loss of Rb expression, but not with recurrence risk. Notably, p16-IHC was not a perfect surrogate marker for high-risk HPV infection; only 64% (16/25) of p16-positive tumors were positive for high-risk HPV. In contrast, the p16+/Rb partial loss pattern was exclusively correlated with high-risk HPV-positivity. The results suggest that the combination of p16 and Rb expression patterns by IHC could be a useful method to predict high-risk HPV infection in conjunctival and lacrimal sac SCCs. HPV infection may be of less prognostic value in this field of cancers.

Myxoid type and non-myxoid type of intimal sarcoma in large vessels and heart: review of histological and genetic profiles of 20 cases.

Intimal sarcoma is one of the most common and well-known primary malignant neoplasms of the aorta and heart. The authors reviewed cases of intimal sarcoma from histological, immunohistochemical and genetic perspectives. Twenty cases of intimal sarcoma were retrieved. Immunohistochemistry and FISH of MDM2 and PDGFRA genes were performed. All 20 tumours were composed of spindle-shaped, stellate, oval or polygonal tumour cells with irregular hyperchromatic nuclei arranged in a haphazard pattern, accompanied by nuclear pleomorphism and frequent mitotic figures. Other histological findings were as follows: abnormal mitosis in 10 cases (50%), necrosis in 15 cases (75%), myxoid stroma in 12 cases (60%), cartilaginous formation in 1 case (5%), haemorrhage in 12 cases (60%) and fibrinous deposition in 14 cases (70%). The tumours were positive for MDM2 in 16 cases (80%), ERG in 4 cases (20%), alpha-smooth muscle actin in 6 cases (30%), desmin in 5 cases (25%) and AE1/AE3 in 4 cases (20%). Immunohistochemical positivity was focal in each case. Loss of H3K27me3 expression was noted in 2 cases (10%). MDM2 and PDGFRA gene amplifications were detected in 11 cases (55%) and 1 case (5%), respectively. Fisher's exact test revealed a significant correlation between MDM2 gene amplification and myxoid stroma (p = 0.0194). No parameters showed any association with the anatomical location of the tumours. It was suggested that myxoid histology of intimal sarcoma may be associated with MDM2 gene amplification and that intimal sarcoma may be divided into myxoid and non-myxoid types.

Pathological review of cardiac amyloidosis using autopsy cases in a single Japanese institution.

AIM: Amyloidosis is a systemic or localized disease of protein deposition characterized by amorphous eosinophilic morphology and positivity of Congo Red staining. The typing of amyloidosis is becoming increasingly important because therapeutic agents for each amyloidosis type have been developed. Herein, the authors review the autopsy cases at an institution to reveal the putative Japanese characteristics of each amyloidosis type and evaluate the clinicopathological significance of each type. MATERIALS AND METHODS: A total of 131 autopsy cases of systemic and localized amyloidosis were retrieved for classification by immunohistochemistry. Immunohistochemistry for transthyretin, amyloid A (AA), immunoglobulin light-chain kappa and lambda, and ß2-microglobulin was performed for all cases. RESULTS: The 131 amyloidosis cases were classified as follows: 71 cases (54.2%) of transthyretin amyloidosis, 32 cases (24.4%) of AA amyloidosis, 8 cases (6.1%) of light-chain amyloidosis, and 5 cases (3.8%) of ß2-microglobulin amyloidosis, along with 15 equivocal cases (11.5%). All cases showed myocardial involvement of amyloidosis. Histopathologically, the transthyretin type was significantly associated with the interstitial and nodular patterns, and with the absence of the perivascular and endocardial patterns. The AA type was significantly associated with the perivascular and endocardial patterns, and with the absence of the nodular pattern. CONCLUSION: The authors revealed the putative characteristics of cardiac amyloidosis in Japan by using autopsy cases. About 90% of amyloidosis cases were successfully classified using only commercially available antibodies.

[Search for the subconsciousness of hospital pharmacists on their practices of blood drawing or injection, and etc].

The purpose of this study was to clarify the subconsciousness of hospital pharmacists regarding them practicing drip infusion or blood drawing for therapeutic drug monitoring (TDM), etc. We conducted a mail-in survey targeting 476 randomly-selected hospital pharmacists. In our survey sheet we presented our "hypothetical condition" i.e., "that medical practices such as drip infusion or blood drawing for TDM by hospital pharmacists be legally allowed" and we asked them 23 items about the pros and cons of this hypothetical condition and its influence on medical practice. Then, using factor analysis, we searched for the subconsciousness of hospital pharmacists from their answers to the 23 items. We then analyzed the causal association between the factors extracted from the survey and the pros and cons of the "hypothetical condition" using logistic regression analysis. 47.7% of respondents agreed to the "hypothetical condition". The results of this research provided 5 factors, consisting of "expectation of medical care and society", "temperament of pharmacists", "pharmacotherapy", "employment", and "medical team". We understood from the result of logistic regression analysis that hospital pharmacists subconsciously had two kinds of expectation, i.e., expectation about medical care and society, and about qualitative improvement of pharmacotherapy, as their background when they decided to agree to themselves practicing drip infusion or blood drawing for TDM, etc.

Image database of Japanese food samples with nutrition information.

BACKGROUND: Visual processing of food plays an important role in controlling eating behaviors. Several studies have developed image databases of food to investigate visual food processing. However, few databases include non-Western foods and objective nutrition information on the foods. METHODS: We developed an image database of Japanese food samples that has detailed nutrition information, including calorie, carbohydrate, fat and protein contents. To validate the database, we presented the images, together with Western food images selected from an existing database and had Japanese participants rate their affective (valence, arousal, liking and wanting) and cognitive (naturalness, recognizability and familiarity) appraisals and estimates of nutrition. RESULTS: The results showed that all affective and cognitive appraisals (except arousal) of the Japanese food images were higher than those of Western food. Correlational analyses found positive associations between the objective nutrition information and subjective estimates of the nutrition information, and between the objective calorie/fat content and affective appraisals. CONCLUSIONS: These data suggest that by using our image database, researchers can investigate the visual processing of Japanese food and the relationships between objective nutrition information and the psychological/neural processing of food.

Case of inflammatory granuloma in inguinal hernia sac after hysterosalpingography with oily contrast medium.

INTRODUCTION: The foreign body reaction caused by oil contrast medium, Lipiodol, is rare. We present a rare case of inflammatory granuloma in the inguinal hernia sac after hysterosalpingography with lipiodol. PRESENTATION OF CASE: A 30-year-old woman who had left inguinal growing mass for 7 months after hysterosalpingography with Lipiodol for examination of infertile. About 3 cm soft mass was palpable on the left inguinal region, and plane CT scan showed a multifocal cystic mass with metal concentration. Thus, laparoscopic herniorrhaphy was performed to repair the inguinal hernia and to confirm the contents of cystic lesion. The hernia sac filled with mucinous contents. Pathological examination revealed that inflammatory granuloma due to numerous lipid droplets and phagocytic images of leukocytes in the hernia capsule. DISCUSSION AND CONCLUSION: Although oil contrast medium is safety agent, there is rear complication which need the surgical treatment. Complete resection of granuloma, including hernia sac, is important to prevent recurrence.

Geriatric nutritional risk index as a prognostic marker of pTNM-stage I and II esophageal squamous cell carcinoma after curative resection.

The geriatric nutritional risk index (GNRI) is associated with mortality in several malignancies. We retrospectively analyzed whether the GNRI can predict long-term outcomes in 191 patients with esophageal squamous cell carcinoma (ESCC) after curative esophagectomies by evaluating their cancer-specific survival (CSS). In multivariate analyses, serum albumin (hazard ratio [HR], 2.498; p = 0.0043), GNRI (HR, 1.941; p = 0.0181), pathological tumor-node-metastasis (pTNM) stage (HR, 3.884; p < 0.0001), and tumor differentiation (HR, 2.307; p = 0.0066) were independent prognostic factors for CSS. In pTNM stage I, multivariate analysis identified C-reactive protein (HR, 7.172; p = 0.0483) and GNRI (HR, 5.579; p = 0.0291) as independent prognostic factors for CSS. In univariate analyses in pTNM stages II and III, only low GNRI (p = 0.0095) and low serum albumin levels (p = 0.0119), respectively, were significantly associated with worse CSS. In patients with low GNRI, CSS was significantly worse than in those with normal GNRI (p = 0.0011), especially in pTNM stages I (p = 0.0044) and II (p = 0.0036) groups, but not in stage III group (p = 0.5099). Preoperative GNRI may sort patients into low- or high-risk groups for shorter CSS, especially in those with pTNM stage I and II ESCC.

Preoperative geriatric nutritional risk index is a useful prognostic indicator in elderly patients with gastric cancer.

BACKGROUND: The geriatric nutritional risk index (GNRI) was developed to evaluate the prognosis in elderly hospitalized patients at risk of malnutrition and related morbidity and mortality. This study aimed to evaluate the relationship between preoperative GNRI and long-term outcomes in elderly gastric cancer patients. MATERIALS AND METHODS: We retrospectively reviewed 297 consecutive patients aged ≥ 65 years who underwent laparoscopic gastrectomy with R0 resection and evaluated their overall survival (OS) and cancer-specific survival (CSS). RESULTS: In the univariate analyses, OS was significantly associated with the American Society of Anesthesiologists Physical Status (ASA-PS), tumor size, tumor differentiation, pathological stage, carcinoembryonic antigen (CEA), C-reactive protein, postoperative complications, and GNRI, whereas in the univariate analyses of CSS, ASA-PS, tumor size, tumor differentiation, pathological stage, CEA, postoperative adjuvant chemotherapy, and GNRI were significantly associated with poor prognosis. In the multivariate analysis, ASA-PS, tumor differentiation, pathological stage, and GNRI were significant independent prognostic factors of OS, whereas ASA-PS, pathological stage, and CEA were significant independent prognostic factors of CSS. CONCLUSIONS: GNRI is significantly associated with OS and CSS in elderly gastric cancer patients and is an independent predictor of OS. It is a simple, cost-effective, and promising nutritional index for predicting OS in elderly patients.

[Search for consciousness of hospital pharmacists on the future prospects of their practices and on their practices of blood drawing or injection].

This research intends to clarify the future prospects of hospital pharmacists and also the factors which influence on their practices of blood drawing or injection by conducting research on their consciousness. We studied it using mail-in survey targeting on randomly selected 476 hospital pharmacists. Study items were the attribution of responders, the prospects of their status in 10 years later, and the system and practices which influence on their future prospects (for example, injection, blood drawing during TDM, and etc.). The collection rate of the questionnaire/inquiry sheet was 37.0%. Regarding their future prospects in 10 years, 65.1% of responders answered they felt pessimistic. Among those system and practices which could influence on the prospects, they answered "Pharmacy specialist system" as the most optimistic and "Diagnosis related group/Prospective payment system (Japanese version; DPC)" as the most pessimistic. Regarding the above mentioned future prospects for injection and blood drawing during TDM by pharmacists, we implemented an exploratory data analysis by applying responders' attribution to a logistic model. The result of it showed that the pharmacists who work longer years, are in charge of drug information, and work in a hospital having more corresponding number of sickbeds per pharmacist had more positive consciousness to the above-mentioned practices. We hope this study results will be utilized as objective information in the discussion on the expansion of pharmacists' job categories.

Adjuvant endocrine therapy in post menopausal women: pharmacological evaluation using decision analysis approach in a Japanese hospital setting.

An optimal adjuvant endocrine therapy is yet to be established for post menopausal women with hormone receptor positive breast cancer. The current therapeutic options include initial, switch, and extended adjuvant therapies. We aimed to determine the most cost-effective therapeutic option using the clinical decision analysis method. It was suggested that aromatase inhibitor monotherapy in initial adjuvant therapy is the most cost-effective and optimal adjuvant endocrine therapy for post menopausal women with hormone receptor-positive breast cancer.