[A case of HIV coinfected with hepatitis B virus treated by entecavir]

A 45-year-old male active homosexual was given a diagnosis of HIV-1 and acute hepatitis B in August 2007. Since his liver function became rapidly impaired, anti-HBV therapy with oral administration of entecavir (ETV) was started, and resulted in a favorable outcome. However, serum concentration of HIV-RNA decreased by log 1.26 within 60 days, which strongly suggested the inhibition of HIV proliferation by ETV. To prevent the appearance of mutated HIV, novel therapeutic strategies should be established in HIV/HBV-coinfected patients.

Successful absorption of antiretroviral drugs after gastrojejunal bypass surgery following failure of therapy through a jejunal tube

Lopinavir, an antiretroviral drug against human immunodeficiency virus (HIV), was administered through various routes to an HIV-infected patient with duodenal malignant lymphoma. Antiretroviral drugs were first administered through a jejunal tube, and then through bypass route between the stomach and jejunum that was 20 cm distal from the ligament of Treitz after surgery. Oral administration through the bypass achieved sufficient serum concentrations of lopinavir, whereas administration through the jejunal tube did not.

[A case of recurrent gastric cancer with peritoneal dissemination--prolonging life and good QOL by chemotherapy with combined use of paclitaxel]

A 55-year-old man with advanced gastric cancer underwent total gastrectomy (T3N0M0, stage II , por, sig) in the USA. Following his return to Japan, the patient then suffered from a recurrence with ileus, bilateral hydronephrosis and ascites caused by peritoneal dissemination. Systemic chemotherapy of paclitaxel combined with 5-FU was performed, and after four cycles, ileus, bilateral hydronephrosis and ascites disappeared. S-1 monotherapy was started to maintain his QOL, but after five cycles, ileus of the transverse colon recurred. Colostomy was performed and systemic chemotherapy of paclitaxel combined with S-1 was performed. For 13 months, the patient's condition remained stable and he returned to society, but died 30 months after the first recurrence. This case suggests that paclitaxel-based chemotherapy is a promising treatment for gastric cancer with peritoneal dissemination.

[Prevention and treatment of nonsteroidal anti-inflammatory drugs induced ulcers]

There are many randomized controlled trials (RCTs) about prevention and treatment for nonsteroidal anti-inflammatory drugs (NSAIDs) induced ulcers in the world. Prevention and treatment about NSAIDs induced ulcers by proton pump inhibitors (PPIs) and misoprostol are well established. Cyclooxygenase (COX)-2 inhibitors reduce ulcers but some reports revealed that these drugs increased cardiovascular adverse events than conventional NSAIDs. In Japan, there are few RCTs about NSAIDs induced ulcers. The approved dosages of NSAIDs are much fewer in Japan than in the United States and Western countries. So it is necessary to study about efficacy and safety of PPIs and misoprostol for Japanese patients and clear the most appropriate dosages of these drugs and distinguish the high risk patients.

Levels of omega-3 fatty acid in serum phospholipids and depression in patients with lung cancer

Previous studies suggested that omega-3 fatty acids (FAs) have therapeutic effects against depression, but there is no evidence in the oncological setting. Our preliminary study reported the association between lower omega-3 FA intake and occurrence of depression in lung cancer patients. To explore the association further, the present study examined whether depression was associated with lower levels of omega-3 FAs in serum phospholipids. A total of 717 subjects in the Lung Cancer Database Project were divided into three groups by two cutoff points of the Hospital Anxiety and Depression Scale depression subscale (HADS-D). In all, 81 subjects of the nondepression and minor depression groups (HADS-D<5 and 5⩽HADS-D⩽10, respectively) were selected to match with 81 subjects of the major depression group (HADS-D>10) for age, gender, clinical stage, and performance status. Fatty acids were assayed by gas chromatography and compared among the three matched groups. There were no differences between the major depression group and nondepression group in any FAs. The minor depression group had higher mean levels of docosahexaenoic acid (mean±s.d. (%), nondepression: 7.40±1.54; minor depression: 7.90±1.40; major depression: 7.25±1.52, P=0.017). These results suggested that serum FAs are associated with minor, but not major, depression in lung cancer patients.

Personality and cancer survival: the Miyagi cohort study

We tested the hypothesis that personality plays a role in cancer outcome in a population-based prospective cohort study in Japan. In July 1990, 41 442 residents of Japan completed a short form of the Eysenck Personality Questionnaire-Revised and a questionnaire on various health habits, and between January 1993 and December 1997, 890 incident cases of cancer were identified among them. These 890 cases were followed up until March 2001, and a total of 356 deaths from all causes was identified among them. Cox proportional-hazards regression was used to estimate the hazard ratio (HR) of death according to four score levels on each of four personality subscales (extraversion, neuroticism, psychoticism, and lie), with adjustment for potential confounding factors. Multivariable HRs of deaths from all causes for individuals in the highest score level on each personality subscale compared with those at the lowest level were 1.0 for extraversion (95% CI=0.8–1.4; Trend P=0.73), 1.1 for neuroticism (0.8–1.6; Trend P=0.24), 1.2 for psychoticism (0.9–1.6; Trend P=0.29), and 1.0 for lie (0.7–1.5; Trend P=0.90). The data obtained in this population-based prospective cohort study in Japan do not support the hypothesis that personality is associated with cancer survival.

Femoral head necrosis in juvenile chronic arthritis

Radiographic signs of ischemic necrosis of the femoral head in terms of abnormal epiphysis and caput indices were found in 30/72 hips in 36 children with hip pain or limitation of motion among 206 children, consecutively admitted during 15 months because of juvenile chronic arthritis. Nine out of 10 hips with obvious signs of femoral head necrosis showed a sclerotic rim at the base of the femoral neck, confirming an earlier episode of ischemic damage to the epiphysis and growth plate. Femoral head necrosis in children with juvenile chronic arthritis seems to be more common than previously reported, and may be caused by circulatory disturbance secondary to increased intraarticular pressure due to synovitis and/or effusion, or to treatment with passive extension of the hip. This should be considered in the treatment and the follow-up of these children.

Abnormal collagen fibrillogenesis in epiphyseal cartilage of CMD (cartilage matrix deficiency) mouse

Light and electron microscopic observations on the structure of epiphyseal cartilages in the cmd/cmd mice, which had genetically failed to synthesize cartilage-characteristic proteoglycan but were normal in type II collagen synthesis, showed apparent abnormalities of collagen fibrils: e.g. increase in the diameter, appearance of periodic banding patterns and bundle-formation of collagen fibrils. These findings suggest that cartilage-characteristic proteoglycan normally limits the lateral growth of collagen fibrils and affects collagen fibrillogenesis in vivo.

[Morphological study of the epiphyseal cartilage in cartilage matrix deficiency (CMD) mouse--a consideration on the roles and functions of cartilage-specific proteoglycan]

Epiphyseal cartilages in mouse with cartilage matrix deficiency due to genetic failure to synthesize cartilage-characteristic proteoglycan were examined under light and electron microscope. Chondrogenesis and proliferation of chondrocytes seemed to occur, though extracellular matrix was small in amount and chondrocytes were packed closely without consistent orientation. In diaphysis, hypertrophic change of chondrocytes and perichondral ossification were observed. In the epiphysis, there was neither zone formation nor column formation, but hypertrophic chondrocytes and calcification in matrix were observed in the area adjacent to the bone shaft. Electron microscopy showed dilatation of rough endoplasmic reticulum, swelling of mitochondria and a large amount of lipid deposition in the chondrocyte. In the cartilage matrix, it was characteristic that a large number of thick collagen fibrils was arranged in parallel and few matrix granule was seen. These findings suggested that cartilage-characteristic proteoglycan was not essential for chondrogenesis, proliferation of chondrocytes and ossification, but were important for cytodifferentiation and chondrocyte activity.