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PURPOSE: Anamorelin, a ghrelin receptor agonist, has recently been approved for gastric, pancreatic, and colorectal cancer patients with cachexia in Japan. However, only few studies have investigated the predictors of response to anamorelin in clinical settings. Thus, our study aimed to investigate the predictors of the response, in addition to its efficacy and safety. METHODS: The clinical outcomes of 20 patients were evaluated during administration. They were divided into two groups based on lean body mass, responders and non-responders, and their clinical characteristics were compared. RESULTS: The mean ± standard error (SE) variations at 12 weeks in lean body mass and handgrip strength were 2.63 ± 0.79 kg and - 1.53 ± 1.20 kg, respectively. The mean ± SE variations at 8 weeks in fasting blood glucose and hemoglobin A1c were 32.88 ± 13.77 mg/dL and 0.90 ± 0.18%, respectively. Total protein, albumin, transferrin, and prognostic nutritional index at baseline were significantly higher in responders (n = 8) than in non-responders (n = 12), whereas the neutrophil/lymphocyte and C-reactive protein/albumin ratios at baseline were significantly higher in non-responders than in responders. CONCLUSION: The study confirmed the efficacy and safety of anamorelin and identified nutritional or systemic inflammatory markers as predictors of anamorelin response in advanced gastrointestinal cancer patients.
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Carcinoma Pulmonar de Células não Pequenas , Neoplasias Gastrointestinais , Neoplasias Pulmonares , Humanos , Caquexia/tratamento farmacológico , Caquexia/etiologia , Estudos Retrospectivos , Força da Mão , Neoplasias Gastrointestinais/complicações , Neoplasias Gastrointestinais/tratamento farmacológico , AlbuminasRESUMO
BACKGROUND: Endoscopic retrograde cholangiopancreatography (ERCP) is a popular technique; however, post-ERCP pancreatitis (PEP) remains a major adverse event. The administration of rectal nonsteroidal anti-inflammatory drugs (NSAIDs) is reportedly effective in preventing PEP. However, the recommended dose varies and the efficacy of low-dose rectal NSAIDs remains unclear. Therefore, we decided to investigate the effectiveness of low-dose rectal diclofenac on PEP prevention, using propensity score matching. METHODS: This single-center retrospective study included 401 patients who underwent ERCP between July 2015 and March 2020. After December 2016, we administered rectal diclofenac within 30 min before the ERCP procedure as widely as possible. Patients were divided into those who did (diclofenac group) and did not (control group) receive rectal diclofenac. Patients weighing ≥ 50 kg were administered a 50 mg dose, while those weighing < 50 kg were administered a 25 mg dose. The incidence and severity of PEP in the two groups were assessed by propensity score matching analysis. RESULTS: Among 401 patients undergoing ERCP, 367 fulfilled the inclusion criteria. Overall, 187 patients received rectal diclofenac (diclofenac group) and 180 did not (control group). After propensity score matching, 105 pairs were selected for evaluation. Overall, seven (6.7%) patients in the diclofenac group and 10 (9.5%) in the control group developed PEP (P = 0.45). Moderate or severe PEP occurred in four (3.8%) patients in the diclofenac group and six (5.7%) in the control group (P = 0.52). CONCLUSIONS: The administration of low-dose rectal diclofenac could not reduce the incidence and severity of PEP.
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Diclofenaco , Pancreatite , Humanos , Diclofenaco/uso terapêutico , Colangiopancreatografia Retrógrada Endoscópica/efeitos adversos , Colangiopancreatografia Retrógrada Endoscópica/métodos , Administração Retal , Estudos Retrospectivos , Pontuação de Propensão , Anti-Inflamatórios não Esteroides/uso terapêutico , Pancreatite/etiologia , Pancreatite/prevenção & controle , Pancreatite/tratamento farmacológicoRESUMO
A 67-year-old woman presented with a history of upper abdominal pain and weight loss. Physical examination revealed a lump in the right lower quadrant. She had undergone esophagogastroduodenoscopy at another hospital ten years ago, which showed a 15-mm elevated lesion in the duodenal bulb. The patient had not undergone further examinations or received treatment during the 10 years. Esophagogastroduodenoscopy conducted in our hospital revealed an enlarged tumor that was difficult to assess on the whole image. The tumor was diagnosed as a well-differentiated adenocarcinoma based on a biopsy specimen. Enhanced computed tomography revealed a hypervascular duodenal tumor with liver and lymph node metastases. The patient was treated with capecitabine plus oxaliplatin for the duodenal cancer. Lymph node metastases increased markedly after 2 courses of chemotherapy. The patient died 3 months after the initiation of chemotherapy. The natural history of sporadic non-ampullary duodenal epithelial tumors remains to be fully elucidated due to the low incidence rate. This case suggests that sporadic non-ampullary duodenal epithelial tumors have a biological potential for invasive malignancy.
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Adenocarcinoma , Neoplasias Duodenais , Feminino , Humanos , Idoso , Neoplasias Duodenais/tratamento farmacológico , Neoplasias Duodenais/cirurgia , Metástase Linfática , Fígado , DuodenoRESUMO
[Purpose] This study aimed to extract knowledge for the development of a training program for creating a social model of disability for physical therapists, focusing on the experiential learning of those physical therapists who did not use acceptance of disability according to their subjective judgment. [Participants and Methods] The study included 11 physical therapists who were interviewed about their use of acceptance of disability and the circumstances leading to its non-use. [Results] The study identified the past and current use of acceptance of disability, as well as cases and reasons for its discontinuation, along with changes in clinical content. [Conclusion] The study extracted knowledge for the development of training programs in line with the components of the experiential learning model.
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BACKGROUND: Knowledge of the bacterial spectrum involved in acute cholangitis is essential for adequate empiric antibiotic treatment. There is a lack of published data comparative data between patients with first and recurrent episodes of acute cholangitis. This study aimed to analyze the microbial spectrum in patients with first and second episodes of acute cholangitis. METHODS: We retrospectively assessed 251 patients with first episodes of acute cholangitis between January 2014 to September 2020. RESULTS: At the first episode of acute cholangitis, the predominant strains belonged to Escherichia coli (17.9%), followed by Klebsiella spp. (15.5%), Enterobacter spp. (6.4%), and Enterococcus spp. (5.6%). During follow-up, acute cholangitis recurred in 109 patients; at the second episode, the predominant strains belonged to Enterococcus spp. (35.8%), followed by Klebsiella spp. (27.5%), Enterobacter spp. (22.9%), and Escherichia coli (15.6%). Enterococcus spp. were the most common pathogen in patients with second episode of acute cholangitis, regardless of whether the cholangitis was caused by a malignant tumor or a benign disease. CONCLUSIONS: Unlike in patients with a first episode of acute cholangitis, clinicians should consider empirical treatment with anti-enterococcal antibiotics in patients with recurrent episodes of acute cholangitis.
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Colangite , Antibacterianos/uso terapêutico , Colangite/tratamento farmacológico , Colangite/epidemiologia , Hospitais , Humanos , Japão/epidemiologia , Testes de Sensibilidade Microbiana , Estudos RetrospectivosRESUMO
BACKGROUND AND AIMS: We examined the efficacy of the combined use of L-menthol spraying (L-mentholS) as an antispasmodic agent and carbon dioxide insufflation (CO2I) on the adenoma detection rate (ADR) in a prospective, single-center trial with a 2 × 2 factorial design. METHODS: We randomly assigned 611 patients scheduled to undergo colonoscopy to 4 groups: (1) the L-mentholS + CO2I (n = 153), (2) L-mentholS + air insufflation (AI; n = 156), (3) CO2I (n = 153), and (4) AI (n = 149) groups. We used 20 mL of 0.8%-L-menthol solution for the L-mentholS. The primary outcome was the difference in the ADR, and the secondary outcomes were the differences in colonic peristalsis and abdominal pain. -Results: The ADRs were not different among the groups: 1/2/3/4; 39.9%/43.6%/41.2%/51.0%. CO2I was associated with a significant decrease in the ADR (OR 0.57; 95% CI 0.35- 0.93) with a multiple logistic regression. The interaction between L-mentholS and CO2I was associated with a suppression of the decrease in the ADR. Both L-mentholS and CO2I were associated with a significant decrease in abdominal pain, and L-mentholS was associated with a significant improvement of peristalsis. CONCLUSIONS: The fact that CO2I was associated with significant decreases in the ADR was a problem. The combined use of L-mentholS and CO2I could help to suppress the decrease in the ADR.
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Adenoma/diagnóstico , Colonoscopia/métodos , Neoplasias Colorretais/diagnóstico , Detecção Precoce de Câncer/métodos , Insuflação , Parassimpatolíticos/administração & dosagem , Dor Abdominal/etiologia , Dor Abdominal/prevenção & controle , Adenoma/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Dióxido de Carbono/administração & dosagem , Colonoscopia/efeitos adversos , Neoplasias Colorretais/epidemiologia , Detecção Precoce de Câncer/efeitos adversos , Feminino , Humanos , Masculino , Mentol/administração & dosagem , Pessoa de Meia-Idade , Peristaltismo/efeitos dos fármacos , Estudos Prospectivos , Resultado do Tratamento , Adulto JovemRESUMO
In recent years, workload has increased with higher precision of radiotherapy. Although both efficiency and thoroughness of treatment are crucial, in such conditions, human error is easy to occur. In this study, five incident cases that occurred in four facilities were studied and analyzed from the viewpoint of human factors that contribute to errors using variation tree analysis. We also analyzed resilience (the ability to return to one's original state even if the system deviates from a stable state), which has attracted attention in recent safety research. There were potential factors represented by patient factors in all cases. These factors caused deviations from standard operations, and incidents occurred due to unfamiliar situations and operations. Furthermore, in four of the five cases, the cause of the incident was a resilience action or judgment that was deemed to have required "some sort of ingenuity or adjustment." It was found that human error occurred due to multiple simultaneous occurrences of potential factors, i.e., patient and human factors such as high workload, impatience, and work interruptions. A reduction in human errors can be achieved by avoiding time pressure and multitasking, creating work environment and working conditions that make resilience work well, revising ambiguous rules and procedures, and promoting standardized working methods.
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Radioterapia , Carga de Trabalho , Local de Trabalho , Humanos , Erros MédicosAssuntos
COVID-19/complicações , Infecção Hospitalar/complicações , Controle de Infecções/métodos , SARS-CoV-2 , Adulto , Idoso , Idoso de 80 Anos ou mais , Suscetibilidade a Doenças , Feminino , Gastroenterologia , Unidades Hospitalares , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Adulto JovemRESUMO
We report results of the segregation induced by the adsorption of O2 and the barrier of the formation of Cu2O in Cu3Au(111) with an experimental and theoretical approach. Oxidation by a hyperthermal O2 molecular beam (HOMB) was investigated by X-ray photoemission spectroscopy in conjunction with a synchrotron light source. From the incident-energy dependence of the measured O-uptake curve, dissociative adsorption of O2 is less effective on Cu3Au(111) than on Cu(111). The dissociative adsorption is accompanied by the Cu segregation on Cu3Au(111) as well as on Cu3Au(100) and Cu3Au(110). The obvious growth of Cu2O for a 2.3 eV HOMB cannot be observed and it suggests that the Au-rich protective layers prevent the diffusion of O atoms into the bulk. The theoretical approach based on density functional theory indicates that O adsorption shows the same behavior on Cu3Au(111) and on Cu(111). For the diffusion case, the barrier to diffuse into the subsurface in segregated Cu3Au(111) is higher than in Cu(111). This indicates that the segregated Au-rich layer in Cu3Au(111) works as a protective layer.
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We report results of our experimental and theoretical studies on the Au concentration profile of Cu3Au(111) during oxidation by a hyperthermal O2 molecular beam at room temperature, using X-ray photoemission spectroscopy (XPS), in conjunction with synchrotron radiation (SR), and density functional theory (DFT). Before O2 exposure, we observe strong Au segregation to the top layer, i.e., Au surface enrichment of the clean surface. We also observe a gradual Cu surface enrichment, and Au enrichment of the second and third (subsurface) layers, with increasing O coverage. Complete Cu segregation to the surface occurs at 0.5 ML O surface coverage. The Au-rich second and third layers of the oxidized surface demonstrate the protective layer formation against oxidation deeper into the bulk.
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Cancer of unknown primary (CUP) and leptomeningeal metastasis are difficult conditions with limited treatment options. We report a case of CUP leptomeningeal metastasis that was refractory to empirical chemotherapy but achieved a favorable response to intrathecal trastuzumab after the identification of human epidermal growth factor receptor-2 (HER2) amplification. A 59-year-old woman was diagnosed with CUP with metastasis of a poorly differentiated carcinoma to the left axillary, anterior mediastinal, peritoneal, and bilateral supraclavicular lymph nodes. Leptomeningeal metastasis was confirmed shortly after she started empiric chemotherapy; empiric therapy with intrathecal methotrexate failed to relieve her symptoms. Meanwhile, the lymph node specimen tested positive for HER2 amplification. She underwent intrathecal trastuzumab, then her neurological symptoms resolved the following day. We suggest that intrathecal trastuzumab is an effective treatment for HER2-positive CUP leptomeningeal metastasis.
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A 50-year-old man presented with fever and a generalized rash, with chronic fatigue and lymphadenopathy for a year and a half. Initial tests ruled out lymphoproliferative disorders, showing reactive hyperplasia and cytomegalovirus. Symptoms worsened after ampicillin treatment, leading to suspected drug-induced hypersensitivity syndrome (DIHS). Upon admission, amoxicillin was discontinued, and prednisolone and antiviral treatment were initiated. The patient's condition improved with this therapy. A drug-induced lymphocyte stimulation test confirmed hypersensitivity to both ampicillin and allopurinol. This case illustrates the diagnostic challenge of chronic and acute DIHS because of the rare presentation. It underscores the need for high suspicion of DIHS in patients with chronic lymphadenopathy and fatigue, particularly with recent drug exposure. Effective management involves recognizing symptoms, withdrawing the offending drug, and using corticosteroids. Viral infections like cytomegalovirus can complicate DIHS diagnosis and treatment, necessitating a comprehensive approach. This case highlights the importance of considering DIHS in differential diagnoses and the complexities of managing it alongside co-infections in rural healthcare settings.
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Lean-burn engines are gaining attention for their lower CO2 emissions, higher thermal efficiency, and improved fuel economy compared to traditional combustion engines. However, they present some difficulty for reducing nitrogen oxides (NOx) because of residual oxygen. To address this difficulty, NOx storage reduction (NSR) system, which combines noble metals and NOx adsorbents, is developed as a viable approach. But it requires cyclic operation, which adversely affects fuel efficiency. A novel approach proposed in this work is electric field-assisted lean NOx reduction, which applies an electric field to the NSR catalyst during lean conditions. This innovation uses surplus vehicle electricity for exhaust purification, enhances hydrogen transfer, and improves NOx reduction, even at low temperatures. Tests with a 3 wt% Pt-16 wt% BaO/CeO2 catalyst demonstrate markedly higher NOx conversion to N2 (13.1% vs. 2.9% without an electric field). This process is effective with extended electric field exposure, doubling the conversion rate. Electric field-assisted lean NOx reduction, by improving NSR technology, can enhance NOx conversion efficiency, reduce emissions, and optimize fuel efficiency in lean-burn engines.
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Pulsed cathodic arc-plasma deposition was employed to create a few nanometre-thick Pt overlayer on a 50 µm-thick Fe-Cr-Al metal (SUS) foil, resulting in an effective NH3 oxidation catalyst fabrication. This catalyst exhibited a turnover frequency (TOF) exceeding 100 times that of Pt nanoparticles. In this study, Pt overlayer catalysts with varying degrees of surface roughness were fabricated using different metal foil substrates: mirror-polished (Pt/p-SUS), unpolished (Pt/SUS) and roughened by the formation of a surface oxide layer (Pt/Al2O3/SUS). The nanoscale roughness was comprehensively analysed using electron microscopy, laser scanning confocal microscopy and chemisorption techniques. NH3 oxidation activity, measured at 200 °C, followed an increasing trend in the order of Pt/Al2O3/SUS < Pt/SUS < Pt/p-SUS, despite a decrease in the apparent Pt surface area in the same order. Consequently, the calculated TOF was markedly higher for Pt/p-SUS (267 min-1) compared to Pt/SUS (107 min-1) and Pt/Al2O3/SUS (≤22 min-1). The smooth Pt overlayer surface also favoured N2 yield over N2O at this temperature. This discovery enhances our fundamental understanding of high-TOF NH3 oxidation over Pt overlayer catalysts, which holds significance for the advancement and industrial implementation of selective NH3 oxidation processes.
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Advanced gastric cancer is a highly aggressive malignancy. The available literature does not provide the prognostic value of ascites based on their degree, because most clinical trials exclude patients who present with massive ascites. Therefore, this study examined whether the presence or degree of ascites has a prognostic value in 124 patients with advanced gastric cancer. The degree of ascites was assessed using computed tomography and classified as none, small, moderate or massive. The overall survival (OS) was compared based on the presence or degree of ascites. Furthermore, a Cox proportional hazards analysis was performed to ascertain the predictors of OS. The cumulative 1-year and 2-year OS rates in patients without ascites were 43.5 and 20.2%, respectively, whereas those in patients with ascites were 29.1 and 13.6%, respectively (P=0.116). The cumulative 1-year and 2-year OS rates in patients without moderate or massive ascites were 39.5 and 20.9%, respectively; however, those in patients with moderate or massive ascites were 28.0 and 4.0%, respectively (P=0.027). Multivariate analysis showed that diffuse-type [hazard ratio (HR), 1.532; 95% confidence interval (CI), 1.002-2.343; P=0.049], moderate or massive ascites (HR, 2.153; 95% CI, 1.301-3.564; P=0.003) and chemotherapy (HR, 0.189; 95% CI, 0.101-0.352; P<0.001) were significant predictive factors of OS. In conclusion, the present study indicated that moderate or massive ascites may influence the OS of patients with advanced gastric cancer.
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Texture and color enhancement imaging (TXI) may improve the visibility of gastric tumors and allow their early detection. However, few reports have examined the utility of TXI. Between June 2021 and October 2022, 56 gastric tumors in 51 patients undergoing endoscopic submucosal dissection at Fukuchiyama City Hospital were evaluated preoperatively using conventional white light imaging (WLI), narrow-band imaging (NBI), and TXI modes 1 and 2. The color differences of the tumors and surrounding mucosae were evaluated using the CIE 1976 L*a*b color space, Additionally, the visibility scores were scaled. Of the 56 gastric tumors, 45 were early gastric cancers, and 11 were adenomas. Overall, the color difference in TXI mode 1 was considerably higher compared to WLI (16.36 ± 7.05 vs. 10.84 ± 4.05; p < 0.01). Moreover, the color difference in early gastric cancers was considerably higher in TXI mode 1 compared to WLI, whereas no significant difference was found in adenomas. The visibility score in TXI mode 1 was the highest, and it was significantly higher compared to WLI. Regarding adenomas, the visibility score in TXI mode 1 was also significantly higher compared to that in WLI. TXI may provide improved gastric tumor visibility.
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Cor , Neoplasias Gástricas , Humanos , Neoplasias Gástricas/diagnóstico por imagem , Neoplasias Gástricas/patologia , Neoplasias Gástricas/cirurgia , Feminino , Masculino , Idoso , Pessoa de Meia-Idade , Imagem de Banda Estreita/métodos , Adenoma/diagnóstico por imagem , Adenoma/patologia , Idoso de 80 Anos ou mais , Adulto , Ressecção Endoscópica de Mucosa/métodos , Aumento da Imagem/métodos , Mucosa Gástrica/diagnóstico por imagem , Mucosa Gástrica/patologiaRESUMO
Bleeding frequently occurs during gastric endoscopic submucosal dissection (ESD) and bleeding points are sometimes difficult to detect. Red dichromatic imaging (RDI) was recently developed to improve the visibility of bleeding. Our study aimed at examining the efficacy of RDI in improving the visibility of bleeding during gastric ESD. We retrospectively evaluated the visibility score and color difference of bleeding spot during gastric ESD during September 2020-January 2021. The visibility score was evaluated as four numeric values by operators, and the color difference between the bleeding spot and surroundings was evaluated using RDI and white light imaging (WLI). A further analysis to evaluate bleeding characteristics was performed to evaluate the possible beneficial effects of RDI. Twenty patients with a total of 85 bleedings were analyzed. The mean visibility score in RDI was significantly higher than that in WLI (3.69 ± 0.60 vs 3.20 ± 0.84, p < 0.01). The color difference with RDI was also significantly higher than that with WLI (19.51 ± 15.18 vs 14.80 ± 7.41, p < 0.01). Furthermore, in the bleedings with a higher visibility score in RDI, the color difference in RDI was significantly higher than that in WLI (23.99 ± 19.29 vs 14.33 ± 7.08, p < 0.01). The multivariate analysis of visibility scores revealed that submergence of bleeding points was independently associated with the superiority of RDI (odds ratio 10.35, 95% confidence interval: 2.76-38.81, p < 0.01). Our study demonstrates that RDI can improve the visibility of bleeding during gastric ESD.
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Ressecção Endoscópica de Mucosa , Neoplasias Gástricas , Humanos , Ressecção Endoscópica de Mucosa/efeitos adversos , Estudos Retrospectivos , Estômago , Hemorragia , Mucosa Gástrica/diagnóstico por imagem , Mucosa Gástrica/cirurgia , Neoplasias Gástricas/diagnóstico por imagem , Neoplasias Gástricas/cirurgiaRESUMO
Pericarditis can cause chest symptoms in dialysis patients. Moreover, it tends to present with various symptoms other than chest pain in patients with end-stage renal disease (ESRD) than in non-ESRD patients. Here, we present the case of an 86-year-old man on maintenance dialysis who was admitted to the hospital with chest discomfort and dyspnea, which led to cardiac tamponade due to unexplained pericardial effusion. The patient underwent pericardial drainage with an epigastric approach. Based on his medical history and pericardial fluid examination, his condition was diagnosed as dialysis-related pericarditis. Non-steroidal anti-inflammatory drugs and prednisolone administration improved the patient's condition. There are various causes of pericarditis in patients undergoing hemodialysis. It is crucial to examine the patient's clinical presentation and pericardial fluid volume to clarify the cause of the disease.
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Factor XIII (FXIII) deficiency is a rare but serious coagulopathy. FXIII is critical in blood coagulation, and FXIII deficiencies can lead to uncontrolled or spontaneous bleeding. FXIII deficiencies can be congenital or acquired; acquired FXIII deficiency can be categorized as autoimmune and non-autoimmune. Immunological tests to measure FXIII inhibitors are required to diagnose acquired FXIII deficiency; however, appropriate test facilities are limited, which increases the turnaround time of these tests. In the case of critical bleeding, delayed test results may worsen prognosis due to delayed treatment. Here, we report a case of acquired FXIII deficiency, followed by a review of FXIII deficiency cases in Japan. We performed a systematic review to investigate the present conditions of the diagnosis and treatment of FXIII deficiency, including the measurement of FXIII inhibitors in Japan. FXIII inhibitor testing was only performed in 29.7 of acquired FXIII deficiency cases. Clinical departments other than internal medicine and pediatrics were often involved in medical treatment at the time of onset. Therefore, it is important for doctors in clinical departments other than internal medicine and pediatrics to consider FXIII deficiency and perform FXIII inhibitor testing when examining patients with prolonged bleeding of unknown cause or persistent bleeding after trauma.