A qualitative study of Japanese patients' perspectives on post-treatment care for gynecological cancer

The perspectives of cancer patients are important for designing a medically and economically effective follow-up program to help in the rapid recovery of patients. However, research focusing on the perspectives of Japanese gynecological cancer patients on follow-up programs is extremely scarce. In this study, we explored the perspectives and expectations of Japanese gynecological cancer patients with regard to post-treatment follow-up. Twenty-eight patients recruited through a gynecological cancer support group were included in focus groups 1-10 years post-treatment. Participants' accounts related to their perspectives on follow-up were coded and grouped into themes according to commonalities and differences. Seven themes emerged as follows: (1) living with uncertainty, (2) monitoring recurrence, (3) test content and frequency, (4) coping with "another illness", (5) provider communication and attitude, (6) holistic care, and (7) compromising with the reality of changed body. While these Japanese gynecological patients regarded follow-up as an opportunity for reassurance, they also wanted treatment for adverse effects and the opportunity to discuss their concerns. On the basis of the study findings, we conclude that during follow-up after cancer treatment, Japanese gynecological cancer patients not only prioritize recurrence management of cancer but also place a significant amount of importance on the management of symptoms and doctor-patient communication. However, these expectations for communication and care are often unmet. Thus, there is a need to fulfill the gap between the current follow-up programs and patients' expectations by reviewing and changing the hospital's policy that mainly focuses on the detection of recurrent diseases.

[Genetic basis for skeletal disease. Orthopaedic intervention for bone dysplasias]

The aims of orthopaedic intervention for bone dysplasias are to maintain joint function, to prevent neurological complications, and then to improve the patient's quality of life. Bone lengthening technique can not only increase the body height, but also correct malalignment of the limb at the same treatment session, which is important to prevent early occurrence of the degenerative osteoarthritis. Intramedullary nailing for osteogenesis imperfecta protects long bones from fractures and prevents malunion when fracture takes place. Spinal instrumentation surgery is effective for prevention of the neurological complications and deterioration of the spinal deformities.

Two novel Salp15-like immunosuppressant genes from salivary glands of Ixodes persulcatus Schulze tick

Salp15, a 15-kDa tick salivary gland protein, is known for several suppressive activities against host immunity and critical functions for the transmission of Lyme borrelia in Ixodes scapularis and Ixodes ricinus, the major vectors found in North America and Western Europe. Salp15 inhibits the activation of cluster of differentiation (CD)4(+)T-cells through the repression of T-cell receptor (TCR)-triggered calcium fluxes and interleukin (IL)-2 production. Furthermore, Salp15 adheres to the spirochaeta and specifically interacts with its outer surface protein C. The binding of Salp15 to Borrelia burgdorferi protects it from antibody-mediated killing in vitro. The aim of this study is to identify the Salp15 genes in Ixodes persulcatus Schulze, the specific vector for human Lyme borreliosis in Japan. Two cDNA clones encoding the Salp15-like sequence were obtained from salivary glands of fed female ticks. These genes encode 135- and 132-amino acid proteins, designated Salp15 Iper-1 and Salp15 Iper-2, respectively, both having signal peptide sequences and predicted to be secretory proteins. Salp15 Iper-1 and -2 showed 51.8 and 68.2% similarity to I. scapularis Salp15, respectively. Reverse transcriptase PCR analysis showed that Salp15 Iper genes were expressed specifically in the salivary glands throughout life cycle stages of the ticks and were up-regulated by blood feeding. In the I. persulcatus-derived sequences, the C-terminal part, which is the binding domain to the CD4 molecule of T-cells in I. scapularis Salp15, was well conserved. In the future, it will be necessary to analyse immunosuppressive functions of I. persulcatus Salp15 and their interaction with Borrelia spp. in Japan.

Pretransplant serum ferritin and C-reactive protein as predictive factors for early bacterial infection after allogeneic hematopoietic cell transplantation

Although fluoroquinolones or other antibiotics are commonly used to prevent bacterial infections after hematopoietic cell transplantation (HCT), because of the growing presence of multidrug-resistant microorganisms, it is important to identify patients who are more likely to benefit from antibacterial prophylaxis. To evaluate risk factors for early bacterial infection after allogeneic HCT, we retrospectively analyzed clinical data for 112 consecutive adult patients with hematological malignancies who received transplants without any antibacterial prophylaxis. The cumulative incidence of bacterial infection at 30 days after transplantation was 16%. Among various pre-transplant factors, only high serum ferritin (>700 ng/mL, 47 patients) and high C-reactive protein (CRP) (>0.3 mg/dL, 28 patients) levels were significantly associated with the development of bacterial infection in a multivariate analysis (hazard ratio (95% confidence interval): ferritin, 4.00 (1.32-12.17); CRP, 3.64 (1.44-9.20)). In addition, septic shock and sepsis with organ failure were exclusively observed in patients who had high ferritin and/or high CRP levels. These results suggest that pretransplant serum ferritin and CRP levels can be useful markers for predicting the risk of early bacterial infection after allogeneic HCT. It may be prudent to limit antibacterial prophylaxis to patients with predefined risk factors to ensure the safety of HCT with the use of fewer antibiotics.

Thumb polydactyly with symphalangism in young children

Six cases of young children with thumb polydactyly in which the radial component was complicated by symphalangism are reported. Since the symphalangism was cartilaginous, plain X-rays showed an apparent joint space. However, its continuity was confirmed at surgery. Thumb polydactyly with symphalangism may be more common than previously expected.

Mirror foot: treatment of three cases and review of the literature

PURPOSE

To describe three cases of mirror foot and to develop a new classification of the mirror feet with an emphasis on their treatment.

METHODS

Surgical treatment was performed on three patients with mirror foot. Mirror feet in the English literature were surveyed and cases found in PubMed as well as our three cases were classified according to a new classification that was an analogy of the mirror hand classification proposed by Al-Qattan et al. (J Hand Surg Br 23:534-536, 1998).

RESULTS

All three cases obtained satisfactory outcome after the treatment. In addition to these cases, 28 mirror feet were well described in the English literature, among which only seven cases have been documented for their treatment. All of the cases could be assigned to one of the categories of the proposed classification.

CONCLUSION

Mirror foot is a very rare congenital deformity of the foot. We successfully treated three novel cases of mirror feet. A classification of the mirror feet proposed in this article was useful in order to understand its nature and obtain a guideline for its treatment.

Expression of HMGA2-LPP and LPP-HMGA2 fusion genes in lipoma: identification of a novel type of LPP-HMGA2 transcript in four cases

BACKGROUND

In a subset of lipoma, a specific t(3;12)(q27-28;q14-15) chromosomal translocation leads to the fusion of the high mobility group A2 (HMGA2) gene and the lipoma preferred partner (LPP) gene. Although the expression of HMGA2-LPP fusion gene has been reported in lipomas, the reciprocal LPP-HMGA2 fusion gene has rarely been described.

MATERIALS AND METHODS

Ninety-eight cases of lipoma were analyzed for the possible expression of HMGA2-LPP and LPP-HMGA2 fusion genes using a reverse-transcription polymerase chain reaction method.

RESULTS

Ten lipomas (10%) revealed both HMGA2-LPP and LPP-HMGA2 fusion transcripts, nine (9%) only HMGA2-LPP, and three (3%) only LPP-HMGA2. DNA sequencing analysis demonstrated that the HMGA2-LPP transcript in 19 lipomas consisted of exons 1-3 of HMGA2 and exons 9-11 of LPP, which was described previously. Out of 13 lipomas with LPP-HMGA2 transcript, 9 were associated with a previously reported LPP-HMGA2 fusion transcript, which fuses exon 8 of LPP to exon 4 of HMGA2, while 4 with a novel type of LPP-HMGA2 fusion transcript, which fuses exon 7 of LPP to exon 4 of HMGA2.

CONCLUSION

In addition to the HMGA2-LPP fusion gene, the LPP-HMGA2 fusion gene could have some specific roles for lipomagenesis. The biological implications of the expression and the variation of LPP-HMGA2 fusion transcripts need to be elucidated.

Chromosome enumeration probe 17 (CEP) ratio to predict chemosensitivity in HER-2 overexpressing breast cancer

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Background: Precise assessment of HER-2 is critical in breast cancers and predicts benefit of trastuzumab (T). Although subset analysis of CALGB 9840 suggests benefit in FISH-negative patients with chromosome 17 polysomy (C17), clinical significance of C17 in FISH-positive patients is still less known. To analyze the epidemiologic feature of C17 in Japanese patients, consecutive operable breast cancer patients during 05–07 treated in single institution were studied. Methods: HER-2 status of consecutive 307 patients excluding DCIS and whose specimens were poor quality for study, were analyzed with Pathvysion (FISH). We defined HER- 2 (+) and C17 as HER-2/chromosome 17 ratio ≥ 2.2 and CEP ratio ≥ 2.2, respectively. Pathological response following neoadjuvant chemotherapy (NACT) was assigned according to the Japanese Breast Cancer Society (G3; no invasive or in situ residual tumor in the breast, G2; up to two thirds of primary cancer cells having pathologically severe changes or disappearance, G1; up to one third to two thirds of primary cancer cells having pathologically severe changes or disappearance). Results: HER-2 (+) was found in 22% (67/307) and C17 in 25% (77/307). Twenty-four of 67(36%) in HER-2 (+) had C17 and 53 of 240 (22%) in HER-2 (-) did C17. Among HER-2 (+), 23 cases received T-contained regimens as NACT (FEC/EC followed by PAC+T in 18 and DOC+CPA+T in 5). Six of 9 (67%) with C17 had G3 and 2 of 14 (14%) with non-C17 did G3. CEP ratio significantly predicts to have G3 (p=0.02) but HER-2/chromosome 17 ratio by logistic regression analysis. Conclusions: C17 was found in 25% of Japanese operable breast cancer patients of which was similar to that of CALGB. CEP ratio is a good predictive marker for chemo- sensitivity in HER-2 (+) subset.

No significant financial relationships to disclose.

Correction of deformity and shortening due to post traumatic epiphyseal arrest by distraction osteogenesis

Growth arrest in the epiphyseal plate during childhood often causes both periarticular deformities and limb length discrepancy, leading to compartmental osteoarthrosis and gait disturbance or spinal disorders, respectively. Distraction osteogenesis using external fixators with hinge systems appears to be useful for the simultaneous correction of deformity and shortening. In this paper, we evaluated cases of lower limbs with periarticular deformities and limb length discrepancy after epiphyseal plate injury that has been treated by distraction osteogenesis using external fixators. This is the first report regarding the outcomes of distraction osteogenesis for a group of patients having deformity and limb length discrepancy due to traumatic arrest of the physis. Successful outcomes may promise the use of this method as the first choice for the treatment of growth disorders after the arrest of the epiphyseal plate in the lower limbs. However, treatment under 20 years of age may provide a better outcome with a lower incidence of complications.

A novel dominant-negative mutation in Gdf5 generated by ENU mutagenesis impairs joint formation and causes osteoarthritis in mice

Growth and differentiation factor 5 (GDF5) has been implicated in chondrogenesis and joint formation, and an association of GDF5 and osteoarthritis (OA) has been reported recently. However, the in vivo function of GDF5 remains mostly unclarified. Although various human GDF5 mutations and their phenotypic consequences have been described, only loss-of-function mutations that cause brachypodism (shortening and joint ankylosis of the digits) have been reported in mice. Here, we report a new Gdf5 allele derived from a large-scale N-ethyl-N-nitrosourea mutagenesis screen. This allele carries an amino acid substitution (W408R) in a highly conserved region of the active signaling domain of the GDF5 protein. The mutation is semi-dominant, showing brachypodism and ankylosis in heterozygotes and much more severe brachypodism, ankylosis of the knee joint and malformation with early-onset OA of the elbow joint in homozygotes. The mutant GDF5 protein is secreted and dimerizes normally, but inhibits the function of the wild-type GDF5 protein in a dominant-negative fashion. This study further highlights a critical role of GDF5 in joint formation and the development of OA, and this mouse should serve as a good model for OA.

Paclitaxel enhances antibody-dependent cell-mediated cytotoxicity of trastuzumab by a rapid recruitment of natural killer cells in Her-2 overexpressing breast cancer

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Background: One of the important mechanisms that trastuzumab (TZ) inhibits the growth of Her-2 overexpressing breast cancer cells is the activation of a host tumor response via antibody-dependent cell-mediated cytotoxicity (ADCC). Although paclitaxel (PTX) has a synergistic effect in combination with TZ, whether the ADCC is enhanced by PTX is less known. We questioned whether adding PTX to TZ enhances ADCC and also investigated kinetics of effector cells in ADCC. Methods: Twenty-eight patients with Her-2 overexpression, 9 received the combination of (4mg/kg as a loading and 2 mg/kg weekly) and PTX (80 mg/m2 weekly) and 19 did monotherapy of TZ, were studied. Using blood samples (mononuclear cells) taken before and 10 minutes after administrations, ADCC and the number of effector cells including NK cell, monocyte, and CD64+ cell were compared in each case (after/before). ADCC was analyzed by 51Cr releasing assay using SK-BR-3 cell line and the fractions of NK cells (both CD16+(FcγRIII) and CD56+) and CD64+(FcγRI) cells were analyzed by flow cytometry. Results: ADCC levels increased in + 9% (mean) after TZ monotherapy and + 120% (p<0.05) after the combination of TZ and PTX. All 9 patients in combination had enhancements in ADCC levels. As regards effector cells, NK cells increased in + 51% after TZ alone and in + 112% (p<0.05) after the combination. No significant changes were found in monocytes (+ 39%) and CD64+ cells (+ 53%) after TZ, however monocytes decreased in - 40% (p<0.05) and also CD64+ in - 24% after the combination. Conclusions: Adding PTX to TZ significantly enhanced ADCC, which level was twice as strong as TZ monotherapy, by a rapid recruitment of NK cells. This may reflect that a combination of TZ and PTX has a strong synergistic effect than we expected in Her- 2 overexpressing breast cancer.

No significant financial relationships to disclose.

Sentinel lymph nodes navigation surgery for stage I or IIA breast cancer patients

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Background: We applied indigocarmine for sentinel lymph nodes staining for Stage I or IIA breast cancer patients. We compared patient survival between sentinel lymph nodes navigastion surgery group and ordinary surgery with axillary lymph nodes dissection group. Methods: Patients consisted of 160 histologically proven breast cancer women (Stage I: 108 cases, Stage II: 52 cases, 51.8 ± 11.1 years, SN group) and other 320 breast cacner women (Stage I: 187 cases, Stage II: 146 cases, 53.4 ± 9.7 years, non-SN group). All patients underwent partial resection of their breast with histologically proven cancer cells negative margin (SN group: May 2000–December 2003, non-SN group: January 1996–December 2003). Fifteeen minutes before surgery, 0.4% Indigocarmine (10 ml) was injected around the tumor by use of 24 gauge syringe. Sentinel lymph node (SN) was defined as the stained lymph node. Intra operative cytology and histopathological examination was performed for SN and one or two lymph nodes around the SN. When any cancer cells were found in either of SN or the lymph nodes around the SN, axillary lymph nodes dissection was performed. When all of SN and several lymph nodes around the SN were diagnosed as cancer cells negative, axillary lymph nodes dissection was omitted. Patient survival and disease free survival were calculated by Kaplan-Meier method. Results: About patients characteristics including age, diameter of the tumor, hormone receptor status, treatment after surgery, etc., no significant difference was found between two groups. We could find SN in 156 patients (97.5%) out of 160 cases in SN group. Four years patient survival was 97.6% (stage I, SN group), 96.6% (stage I, non SN group), and 96.6% (stage IIA, SN group), 93.5% (stage IIA, non SN group), respectively (no significant difference). Four years disease free survival was 97.6% (stage I, SN group), 95.4% (stage I, non SN group), and 82.5% (stage IIA, SN group), 86.4% (stage IIA, non SN group), respectively (no significant difference). Conclusions: Sentinel lymph nodes navigation surgery for stage I or IIA breast cancer patients by use of 0.4% Indigocarmine revealed comparable patient survival and disease free patient survival to ordinary surgery.

No significant financial relationships to disclose.

Spine and rib abnormalities and stature in spondylocostal dysostosis

STUDY DESIGN

A retrospective study of radiographic and clinical findings of spondylocostal dysostosis.

OBJECTIVE

To determine the features of spondylocostal dysostosis diagnosed using consistent diagnostic criteria.

SUMMARY OF BACKGROUND DATA

To our knowledge, no clear definition of spondylocostal dysostosis exists, and little information is available regarding its clinical or radiographic features.

METHODS

We defined spondylocostal dysostosis as a congenital spinal disorder consisting of >or=2 vertebral anomalies associated with rib anomalies, without crab-like chest. For 30 patients, including 12 males and 18 females, who met these criteria, we evaluated vertebral and rib anomalies, birth and present body height, and associated anomalies. There were only 2 familial cases.

RESULTS

Features of spondylocostal dysostosis were: (1) anomalies involved the thoracic region in all cases; many also involved the cervical spine; (2) most patients had >or=4 vertebral anomalies; (3) frequent vertebral anomalies were butterfly vertebra, hemivertebra, complete block, and unilateral bar, which were associated with both rib absence and fusion; (4) short stature was not always present at birth; and (5) complete block was 1 factor identified as being related to short stature after 12 years of age.

CONCLUSION

Several features of sporadic spondylocostal dysostosis disorder were determined, including new findings related to body height.