Simple criteria to predict prognosis in colorectal carcinoma based on lymphopenia and thrombocytosis

The aim of the present study was to establish a series of criteria based on lymphopenia and thrombocytosis to determine prognosis for patients with colorectal carcinoma. Correlation of preoperative lymphopenia and thrombocytosis with clinicopathological characteristics was investigated in 215 patients with colorectal carcinoma who had undergone surgical treatment. Multivariate analysis showed that the presence of at least either lymphopenia or thrombocytosis (P=0.006), venous invasion (P=0.003) and the stage of tumors (P=0.019) were independent prognostic indicators. Lymphocyte percentage and platelet counts that can be determined using only data from complete blood counts may therefore serve as simple and useful tools to appropriately determine prognosis for patients with colorectal carcinoma.

Unilateral multicentric cancer of the breast containing two different histopathological types: Case report

Unilateral multicentric cancer of the breast containing a tumor with a specific histopathological type is comparatively rare. We, herein, report a case of an unilateral multicentric cancer of the breast containing two separate tumors diagnosed as a papillo-tubular carcinoma and an invasive lobular carcinoma. In addition to the difference in histological type, these two tumors also had different patterns of expression of hormonal receptors reflecting the cellular aggressiveness. Therfore, these tumors may be formed through multicentric tumorigenesis.

Pathological Prognostic Score: a rational criteria to stratify survival in colorectal carcinoma

PURPOSE

The aim of this study is to certify a rationality of Pathological Prognostic Score (PPS) in determining the prognosis of patients with colorectal carcinoma.

METHODS

Three hundred and thirty-one patients with colorectal carcinoma, which had been treated by surgical resection, were enrolled. One point was added for each element among four tumor-related pathological factors of depth of tumor, lymph node metastasis, venous invasion, and lymphatic invasion. PPS was determined by an aggregate of the points.

RESULTS

There existed a significant difference both between survivals of patients with PPS 0 or 1 and 2 or 3 (P = 0.0005) and between survivals of patients with PPS 2 or 3 and 4 (P < 0.0001).

CONCLUSIONS

PPS could be an easy and useful criteria to stratify prognosis of patients with colorectal carcinoma.

Pedestrian flow through multiple bottlenecks

We investigate the dynamics of the evacuation process with multiple bottlenecks using the floor field model. To deal with this problem, we first focus on a part of the system and report its microscopic behavior. The system is controlled by parameters of inflow and the competitiveness of the pedestrians, and large inflow leads to a congested situation. Through simulations, the metastable state induced by conflicts of pedestrians is observed. The metastability is related to the phase transition from free flow to congestion. The critical condition of the transition is theoretically derived. In addition, we give simulation results of situations with multiple bottlenecks. They imply that local improvement of pedestrian flow sometimes adversely affects the total evacuation time, and that the total optimization of the system is not straightforward.

Effect of prolongation of operative time on the outcome of patients with gastric carcinoma

The aim of the present study was to analyze the effect of the prolongation of operative time (OT) on the prognosis of patients with gastric carcinoma. In total, 330 patients with gastric carcinoma were enrolled. Correlation of OT with clinicopathological features including the prognosis of the patients were analyzed. Although tumors of patients for whom the OT was longer proved to be at a significantly more advanced stage of disease and univariate analysis demonstrated that the prognosis of these patients was significantly unfavorable, tumor stage was the only factor independently associated with worse prognosis for the patients based on multivariate analysis. Duration of OT was not an independent prognostic indicator. However, OT is dependent on the surgical procedure to treat tumor progression of gastric carcinoma.

Positive congestion effect on a totally asymmetric simple exclusion process with an adsorption lane

We propose a type of asymmetric simple exclusion process by introducing an adsorption lane. In the system, each particle can be adsorbed by the adsorption lane only once per travel. The adsorption and desorption probabilities control the density of adsorption sites and the number of adsorbed particles. The ratio of the adsorbed particles shows reversal dynamics for congestion of the system, which is called the "positive congestion effect." We analyze this phenomenon by simulations and an approximation and successfully derive its critical condition. The spatial distribution of particles controlled by the adsorption and desorption probabilities is also investigated through balance equations of particles.

Exact solution of a heterogeneous multilane asymmetric simple exclusion process

We have proved an exact solution of a multilane totally asymmetric simple exclusion process (TASEP) with heterogeneous lane-changing rates on a torus. In the expression, the TASEP in each lane and lane-changing transition can be separable. Moreover, the lane-changing transitions satisfy the detailed balance condition, and this is the key to constructing the solution. Using the saddle-point method, the current of particles has been derived in a simple form in a thermodynamic limit. It is interesting that the dynamics depends only on a set of lane-changing parameters, not on the configuration of lanes.

Gastro-pancreaticostomy using a tube stent as a less invasive palliative treatment for malignant obstructive pancreatitis

Surgical palliation of malignant obstructive pancreatitis poses a considerable burden to patients, especially those with extensive disease. We herein present a novel technique for performing gastro-pancreaticostomy using a tube stent as a less invasive palliative treatment for malignant obstructive pancreatitis. The main pancreatic duct was punctured via the wall of the pyloric antrum. After the insertion of a guidewire, a double pigtail-type tube stent with side holes was inserted into the main pancreatic duct through the wall of the pyloric antrum. This technique was useful as a means of accomplishing less invasive palliative treatment, and has the potential to improve the quality of life for patients with malignant obstructive pancreatitis.

Primary neuroendocrine carcinoma of the breast: report of a case

Primary neuroendocrine carcinoma (NEC) of the breast appears to be a rare neoplasm. Due to the limited number of the cases, a definitive therapeutic option for the disease has not yet been established. We herein report the case of a 57-year-old female patient with primary NEC of the breast who underwent a surgical resection and for whom the suitable adjuvant therapy is now being considered.

Assessment of predictors of mortality and severity in patients with colorectal perforation

Colorectal perforation is a life-threatening disease with high mortality and morbidity. The correct and prompt diagnosis and accurate judgment of severity are necessary. We retrospectively investigated 30 patients with colorectal perforation to assess predictors of mortality and severity, and evaluated the usefulness of computed tomography (CT) for the initial diagnosis. The severity of peritonitis was assessed using clinical factors and Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (POSSUM) scores. Abdominal free air was detected by CT in 92% of patients with colorectal perforation, whereas only 36.6% showed evidence of abdominal free air by conventional radiography. The perforation site was correctly diagnosed in 14 of 25 cases (56%). Overall mortality was 16.7%. Survivors were younger than nonsurvivors, and POSSUM physiological and mortality scores were significantly lower for survivors compared with nonsurvivors. The amount of intraperitoneal soiling by large bowel content determined disease severity in terms of the need for postoperative respiratory management. In conclusion, CT is necessary for precise diagnosis, and the POSSUM score is helpful for the evaluation of disease mortality and severity.

[Prominent efficacy from capecitabine mono-therapy for a case with lymphangiosis carcinomatosa derived from recurrent breast cancer]

We met a 61-year-old woman who had been suffering from dyspnea due to pleuritis carcinomatosa derived from recurrent breast cancer for which no former chemotherapy had been effective. Capecitabine mono-therapy could exert a drastic anticancer effect for lymphangiosis carcinomatosa causing more severe symptoms of dyspnea. This therapeutic option could be selected for patients with recurrent breast cancer for which the first- or second-line chemotherapy could not provide a sufficient anti-cancer efficacy and possibly serve to sustain the life quality of the patients.

Serum appearance of anti-p53 antibody in triple negative breast cancer

BACKGROUND

Significance of serum appearance of anti-p53 antibody in breast cancer has not been discussed fully.

METHODS

The relationship between serum appearance of anti-p53 antibody and the clinicopathological features was investigated on the basis of the data of 42 women with breast cancer who had been treated with surgical resection.

RESULTS

The proportion of tumors with histological grade 3 was significantly higher among tumors with serum appearance of anti-p53 antibody (P = 0.020). The proportion of triple negative tumors was also significantly higher among tumors with serum appearance of anti-p53 antibody (P = 0.003).

CONCLUSIONS

Preoperative appearance of anti-p53 antibody in sera can be correlated with the incidence of triple negative breast cancer and could therefore help identify tumors with aggressive potential.

Significance of modified Glasgow prognostic score as a useful indicator for prognosis of patients with gastric carcinoma

BACKGROUND

The significance of the Glasgow prognostic score (GPS), an inflammation-based prognostic score, as an indicator of aggressiveness in gastric carcinoma has not been investigated fully.

METHODS

Two hundred thirty-two patients with gastric carcinoma were enrolled. Patients who had both an elevated C-reactive protein (>1.0 mg/dL) and hypoalbuminemia (<3.5 g/dL) were allocated a traditional GPS (TGPS) of 2. Patients who had one of these abnormal values were allocated a TGPS of 1, and patients who had neither were allocated a TGPS of 0.

RESULTS

There existed a significant difference between the survival of adjacent groups of patients when examined using the TGPS (P = .05 for TGPS 0 vs 1 and P = .006 for TGPS 1 vs 2). Multivariate analysis based on TGPS demonstrated that TGPS (P = .020) and tumor stage (P = .0007) proved to be independent prognostic indicators for worse prognosis.

CONCLUSIONS

The preoperative measurement of an inflammation-based prognostic score can demonstrate a strict stratification for the prognosis of patients with gastric carcinoma.

Pathological prognostic score as a simple criterion to predict outcome in gastric carcinoma

PURPOSE

The aim of this study was to establish a simple criterion to predict prognosis of patients with gastric carcinoma.

METHODS

Two hundred four patients with gastric carcinoma, who had been treated with curative resection, were enrolled. One point was added for each category among four pathological factors of depth of tumor, lymph node metastasis, venous invasion, and lymphatic invasion. Pathological Prognostic Score (PPS) was determined by an aggregate of these points for each category.

RESULTS

There existed a significant difference between survivals of patients with PPS 0 or 1 and 2 or 3 (P = 0.0002). Similarly, there also existed a significant difference between survivals of patients with PPS 2 or 3 and 4 (P = 0.010).

CONCLUSIONS

PPS can be quite simple criteria to predict prognosis of gastric carcinoma with a strict stratification.

Factors stimulating propagation of legionellae in cooling tower water

Our survey of cooling tower water demonstrated that the highest density of legionellae, >/=10 CFU/100 ml, appeared in water containing protozoa, >/=10 MPN/100 ml, and heterotrophic bacteria, >/=10 CFU/100 ml, at water temperatures between 25 and 35 degrees C. Viable counts of legionellae were detected even in the winter samples, and propagation, up to 10 CFU/100 ml, occurs in summer. The counts of legionellae correlated positively with increases in water temperature, pH, and protozoan counts, but not with heterotrophic bacterial counts. The water temperature of cooling towers may promote increases in the viable counts of legionellae, and certain microbes, e.g., protozoa or some heterotrophic bacteria, may be a factor stimulating the propagation of legionellae.

Prognostic nutritional index: a tool to predict the biological aggressiveness of gastric carcinoma

PURPOSE

The prognostic nutritional index (PNI), which is calculated based on the serum albumin concentration and the peripheral blood lymphocyte count, has been used to assess the immunological and nutritional condition of patients with digestive diseases. However, its value as an indicator of aggressiveness in gastric carcinoma has not been fully investigated.

METHODS

Two hundred and forty-eight cases of gastric carcinoma were studied with regard to the relationship between the preoperative PNI value and the clinicopathological characteristics of the patients.

RESULTS

A lower preoperative PNI value significantly correlated with greater tumor depth, lymph node metastasis, lymphatic permeation, and venous invasion. Moreover, the PNI value proved to be an independent prognostic indicator in gastric carcinoma.

CONCLUSION

The PNI value can be a useful tool to predict the prognosis of patients with gastric carcinoma.

Squamous cell carcinoma of the breast

Squamous cell carcinoma (SCC) of the breast is comparatively rare. Because of the small number of investigations based on sufficient population size, its clinicopathological features have not been fully elucidated. We report herein a patient with SCC of the breast who underwent surgical resection and whose therapeutic options are now considered.

Four novel resistance integron gene-cassette occurrences in bacterial isolates from zhenjiang, china

Integrons, which are widely distributed among bacteria and are strongly associated with resistance, are specialized genetic elements that are capable of capturing, integrating, and mobilizing gene cassette. In this work, we investigated classes 1, 2, and 3 integrons associated integrases genes in 365 bacteria isolates, amplified and analyzed the structure of class 1 integron, detected 8 resistant gene cassettes [dfr17, aadA5, aadA1, aadA2, dhfrI, aadB, aac(6')-II, and pse-I], and found four novel gene-cassette arrays. We also found that commensal bacteria in the common microenvironment had the same integron gene cassette, which provided direct evidence that integron was an important horizontal transmission element.

Preoperative elevation of serum C-reactive protein as an independent prognostic indicator of colorectal carcinoma

PURPOSE

The preoperative elevation of serum C-reactive protein (CRP) is thought to be a prognosticator of carcinomas of the digestive tract. We conducted this study to investigate the clinical importance of the preoperative elevation of serum CRP in patients with colorectal carcinoma (CRC).

METHODS

We investigated the correlation between an elevated preoperative serum CRP level and the clinicopathologic factors, including prognosis, of 116 patients who underwent resection of CRC.

RESULTS

Forty-seven (40.5%) patients had an elevated serum CRP value preoperatively (group H) and 69 (59.5%) did not (group L). There were significant differences in the tumor size, proportion of poorly differentiated tumors, depth of invasion, lymph node metastasis, lymphatic invasion, and tumor stage between the two groups. Survival was significantly lower in group H than in group L (P < 0.0001). Multivariate analysis showed that the preoperative elevation of serum CRP (P = 0.0007), as well as poor differentiation (P = 0.027) and advanced tumor stage (P = 0.007) were independent prognostic factors in patients with CRC.

CONCLUSION

We found the preoperative elevation of serum CRP to be an independent prognostic indicator of CRC.

Current status of Japanese emergency medicine based on a cross-sectional survey of one prefecture

OBJECTIVE

To ascertain the current status of emergency medicine at certified emergency hospitals in Fukuoka, a Japanese prefecture. Fukuoka prefecture has the 9th largest population volume of the 46 prefectures throughout Japan.

METHODS

Written questionnaire sent to 146 certified emergency hospitals.

RESULTS

A total of 132 of 146 (90.4%) emergency hospitals replied. Data were complete from 131. Nineteen of 131 hospitals (14.5%) were qualified by the Japanese Association for Acute Medicine, whereas 85 of 131 (64.9%) were certified by other medical associations. In 32 of 131 hospitals (24.4%), there was an emergency medicine specialist or acute care physician, whereas 117 hospitals (89.3%) had a specialist doctor qualified by another medical association. In 33 of 131 hospitals (25%), there were doctors who undertook training in emergency medicine of surgery-related courses, and 66 (50%) undertook internal medicine-related courses.

CONCLUSION

The current status of emergency medicine practice in the Fukuoka prefecture is poor. Medical associations relevant to emergency medicine should collaborate with each other to share information, as well as provide help to solve problems associated with emergency medicine manpower. This collaboration should occur as a national effort within the Japanese Association for Acute Medicine.

Rapid detection of Brucella spp. by the loop-mediated isothermal amplification method

AIMS

To develop a rapid and sensitive method for detecting Brucella spp.

METHODS AND RESULTS

Two sets of six Brucella-specific primers for loop-mediated isothermal amplification (LAMP) were designed from the sequence of the Brucella abortus BCSP31 gene. The specificity and sensitivity were examined for six Brucella species (22 strains) and 18 non-Brucella species (28 strains). The LAMP assay was specific to Brucella spp. in 35 min at 63 degrees C and sensitive (detected 10 fg of genomic DNA). The assay was also applied for the detection of Brucella DNA in contaminated milk and infected mouse organs.

CONCLUSIONS

We developed a sensitive and specific LAMP assay for Brucella spp., with the test appearing to be useful for the detection of the pathogen from clinical and food samples.

SIGNIFICANCE AND IMPACT OF THE STUDY

This is the first report of the development of LAMP for the detection of Brucella spp. As the LAMP assay can be performed at a constant temperature and its reactivity is directly observed with the naked eye without electrophoresis, our assay should be useful for the diagnosis of brucellosis as well as the detection of the bacteria in environmental or food samples.

Emergency medicine in Japan. A look at a current university hospital and the problems faced

At present, some outstanding problems regarding Japanese emergency medicine are a serious lack of staff for emergency departments and a great demand for emergency medicine specialists. Medical associations relevant to emergency medicine should collaborate with each other to share what information they have, as well as putting in place provisions to help solve problems associated with emergency medicine. This collaboration should occur nationwide with the Japanese Association for Acute Medicine.

Levels of calcium, magnesium and zinc in urine among adult women in relation to age with special reference to menopause

OBJECTIVES

This study was initiated to examine, on a basis of large-scale epidemiology, if urinary calcium (Ca), magnesium (Mg) and zinc (Zn) levels change as a function of age and menopause.

METHODS

Spot urine samples were collected from adult women, and analyzed for the minerals. Additional information e.g. on smoking habits was obtained by questionnaires, so that cases were classified into 10,464 never-smokers, 1,351 current smokers and 343 past smokers. The mineral concentrations were evaluated as observed (e.g. Ca-U(ob)), and after correction for creatinine (CR) concentration (e.g. Ca-U(cr)) or specific gravity (SG) (e.g. Ca-U(sg)).

RESULTS

Analyses with never-smokers showed that age-dependent changes in Ca-U(ob), Mg-U(ob) and Zn-U(ob) were minute. Menopause induced a small increase in Ca-U(ob) and a small decrease in Zn-U(ob). Values after CR or SG correction were increased in accordance with both age and menopause, possibly due to age- and menopause-associated decreases in urine density.

CONCLUSIONS

Ca-U(ob), Mg-U(ob) and Zn-U(ob) did not vary substantially throughout life. Ca-U(ob) and Zn-U(ob) were slightly higher and lower, respectively, in post-menopausal women than in pre-menopausal women, but such changes were too small to affect life-long stabilities. Thus, the urinalyses did not suggest need of additional supply of Ca, Mg or Zn at advanced ages. Correction for CR or SG may induce a bias in evaluation of age-dependent changes in mineral concentrations, because CR and SG decrease in accordance with age.