Safety of UFT/LV and S-1 as adjuvant therapy for stage III colon cancer in phase III trial: ACTS-CC trial

BACKGROUND

The Adjuvant Chemotherapy Trial of TS-1 for Colon Cancer (ACTS-CC) is a phase III trial designed to validate the non-inferiority of S-1 to UFT/leucovorin (LV) as postoperative adjuvant chemotherapy for stage III colon cancer. We report the results of a planned safety analysis.

METHODS

Patients aged 20-80 years with curatively resected stage III colon cancer were randomly assigned to receive UFT/LV (UFT, 300 mg m(-2) per day as tegafur; LV, 75 mg per day on days 1-28, every 35 days, 5 courses) or S-1 (80, 100, or 120 mg per day on days 1-28, every 42 days, 4 courses). Treatment status and safety were evaluated.

RESULTS

Of 1535 enrolled patients, a total of 1504 (756 allocated to S-1 and 748 to UFT/LV) were analysed. The completion rate of protocol treatment was 77% in the S-1 group and 73% in the UFT/LV group. The overall incidence of adverse events (AEs) were 80% in S-1 and 74% in UFT/LV. Stomatitis, anorexia, hyperpigmentation, and haematological toxicities were common in S-1, whereas increased alanine aminotransferase and aspartate aminotransferase were common in UFT/LV. The incidences of grade 3 AEs were 16% and 14%, respectively.

CONCLUSION

Although AE profiles differed between the groups, feasibility of the protocol treatment was good. Both S-1 and UFT/LV could be safely used as adjuvant chemotherapy.

Delimitation of a QTL region controlling cold tolerance at booting stage of a cultivar, 'Lijiangxintuanheigu', in rice, Oryza sativa L

Low temperature at the booting stage of rice causes male sterility resulting in severe yield loss. Cold tolerance has long been an important objective in rice breeding. We identified a quantitative trait locus (QTL) for cold tolerance on the long arm of chromosome 3 from the cold-tolerant breeding line 'Ukei 840' by using F(2) and BC(1)F(2) populations from crosses between 'Ukei 840' and 'Hitomebore'. The cold tolerance of 'Ukei 840' is derived from the Chinese cultivar 'Lijiangxintuanheigu'. The effect of this QTL on cold tolerance was confirmed by developing 'Hitomebore' chromosome segment substitution lines having 'Lijiangxintuanheigu' alleles on chromosome 3. By producing recombinants in chromosome 3, the QTL region for cold tolerance was delimited to the region of about 1.2-Mb region between RM3719 and RM7000. All lines heterozygous for the QTL showed seed fertilities as low as that of 'Hitomebore', suggesting that the 'Lijiangxintuanheigu' allele for cold tolerance in the QTL region is recessive. Determination of a 1.2-Mb nucleotide sequence of 'Ukei 840' and comparison with the published genomic sequence of 'Nipponbare' showed 254 SNPs, of which 11 were in coding regions of genes, seven in five genes being non-synonymous. SNPs were detected in the 5-kb upstream regions of 89 genes, but no differences of gene expression levels were detected between alleles of these genes. Although further delimitation is required to identify the gene responsible for cold tolerance of 'Lijiangxintuanheigu', SNP markers developed here will be useful for marker-assisted selection in a breeding program using 'Lijiangxintuanheigu' as a donor of cold tolerance.

Improvement of tardive dyskinesia and dystonia associated with aripiprazole following a switch to quetiapine: case report and review of the literature

WHAT IS KNOWN AND OBJECTIVE

Aripiprazole has a low risk of extrapyramidal symptoms. Switching to aripiprazole has been reported to improve tardive dyskinesia caused by other medications. The authors report a case and review previous reports of dystonia and dyskinesia associated with aripiprazole.

CASE SUMMARY

We present a case of a 22-year-old man with schizophrenia who experienced dyskinesia and dystonia associated with aripiprazole. Switching from olanzapine to aripiprazole resulted in worsening dyskinesia and new onset of dystonia. The patient's dyskinesia and dystonia improved after switching from aripiprazole to quetiapine therapy.

WHAT IS NEW AND CONCLUSION

There were several previous case reports on dyskinesia and dystonia associated with aripiprazole medication. The risk factors for tardive dyskinesia include older age and female sex. However, our case was a male patient who was younger compared with the previous cases and so should have been less at risk for dyskinesia in comparison with the previous cases. The effects of aripiprazole can include tardive movement disorders. Dyskinesia, dystonia and psychotic symptoms were improved with relatively small dose of quetiapine in this case. Whether some second-generation antipsychotics are more effective than others in the treatment of tardive dyskinesia remains unclear.

Amnesia in frontotemporal dementia with amyotrophic lateral sclerosis, masquerading Alzheimer's disease

A 68-year-old man with a clinical diagnosis of Alzheimer's disease (AD) later developed amyotrophic lateral sclerosis (ALS), which was confirmed at autopsy at age 72 years. Because neuronal loss and AD-type pathologies (Braak stage II for neurofibrillary tangles) were scant, TDP-43-positive intracytoplasmic inclusions in hippocampal dentate granular cells and in neurons in the subiculum and amygdala, even though small in amount, may represent the earliest lesions of ALS-related dementia and could be the cause of dementia in this patient. Although the persistent elevation of creatine kinase from the onset could be a pointer to the presence of motor involvement, more accurate characterization of dementia, which may differentiate ALS-related dementia and AD, is necessary.

[Electroablation for the treatment of spontaneous pneumothorax using SOFT COAG electrosurgical output system]

We evaluated the validity of the SOFT COAG electrosurgical output system for the treatment of spontaneous pneumothorax. From April 2008 to May 2010, we compared 64 patients who had undergone bullae resection using endoscopic linear staplers, to 20 patients subjected to electroablation of the bullae using the SOFT COAG output system. There was no significant difference between the 2 groups in terms of operation time, bleeding, and mean duration of postoperative chest tube drainage. Postoperative recurrence was apparent in 3 cases for the linear stapler, and in 2 cases for SOFT COAG. Electroablation using the SOFT COAG output system was suggested to be valid for treatment of spontaneous pneumothorax.

Mechanical Properties and Thermal Stability of Yttria-Doped Tetragonal Zirconia Polycrystals with Diffused Ceria in the Surface

Yttria-doped tetragonal zirconia polycrystals (Y-TZP) containing 2 and 3 mol% of Y2O3 uniformly alloyed by 0-15 mol% of CeO2 or diffusing CeO2 on the surface were fabricated, and the mechanical properties and thermal stability of the sintered bodies were evaluated by annealing in humidity conditions at 50–600° C. The tetragonal-to-monoclinic phase transformation proceeded at 100–500°C in air, and accompanied microcracks. The phase transformation proceeded rapidly on the surface, but slowly inside the body. The bending strength of the annealed specimens depended on the depth of the transformation layer thickness, but not on the degree of the phase transformation on the surface. Alloying CeO2 was useful to improve the thermal stability of Y-TZP, but noticeably decreased the fracture strength. Diffusing CeO2 on the suface of Y-TZP seemed to be useful to improve the thermal stability without loss of the fracture strength.

Novel procedure, SILSOID colectomy, is a bridge between conventional and single-incisional laparoscopic colectomy

INTRODUCTION

Laparoscopic colectomy (LC) is a widely accepted treatment for various diseases of the colon. Transumbilical single-incisional laparoscopic surgery (SILS) offers excellent cosmetic results compared with standard multi-port laparoscopic surgery. We describe a new hybrid laparoscopic procedure, SILSOID colectomy, which combines conventional LC with SILS.

METHODS

We performed SILSOID colectomy to treat four patients with colorectal disease. Three ports were inserted through the single transumbilical incision, and an additional port was inserted in the flank at a site that depended on the location of the lesion. Division and anastomosis of the colon were performed extracorporeally.

RESULTS

SILSOID colectomy was carried out uneventfully in all four cases. The median operation time was 220 minutes (range, 179-320 min), and the median blood loss was negligible (range, negligible-285 mL), respectively. Although one patient experienced a postoperative wound infection, no other postoperative complications occurred.

CONCLUSION

SILSOID colectomy is safe and feasible and it can be used as an alternative to conventional LC. We consider this procedure to be a bridge between conventional LC and more advanced laparoscopic procedures, such as SILS.

Five-Fingered Haptic Interface Robot: HIRO III

This paper presents the design and characteristics of a five-fingered haptic interface robot named HIRO III. The aim of the development of HIRO III is to provide a high-precision three-directional force at the five human fingertips. HIRO III consists of a 15-degrees-of-freedom (DOF) haptic hand, a 6-DOF interface arm, and a control system. The haptic interface, which consists of a robot arm and hand, can be used in a large workspace and can provide multipoint contact between the user and a virtual environment. However, the following problems peculiar to a multi-DOF robot have arisen: a large amount of friction, a backlash, and the presence of many wires for many motors and sensors. To solve these problems, a new mechanism and a wire-saving control system have been designed and developed. Furthermore, several experiments have been carried out to investigate the performance of HIRO III. These results show the high-precision force display and great potential of HIRO III.

Increased risk of bacterial infection after engraftment in patients treated with allogeneic bone marrow transplantation following reduced-intensity conditioning regimen

Although bacterial infection is a major cause of death even after reduced-intensity conditioning (RIC) for allogeneic stem cell transplantation (SCT), little is known about the epidemiology and risk factors. The incidence of bacterial infection in 43 patients who received allogeneic bone marrow transplantation (BMT) using a RIC regimen was compared with that in 68 patients who received BMT using a myeloablative conditioning regimen, and risk factors for bacterial infection were identified. Before engraftment, incidences of febrile neutropenia (FN) and documented infections (DI) were significantly decreased in RIC patients (FN: 59.5% vs. 89.6%, P<0.01, DI: 4.8% vs. 17.9%, P<0.01). However, incidence of bacterial infection was significantly increased in RIC patients in the post-engraftment phase (53.8% vs. 11.1%, log-rank, P<0.01). Blood stream was the most frequent focus of infection in both groups. In multivariate analysis, RIC and acute graft-versus-host disease were revealed to be significant risk factors for bacterial infection in this phase. In summary, risk of bacterial infection after engraftment was significantly higher in RIC patients, although infection was decreased before engraftment, and we need to develop a RIC-specific strategy against bacterial infection after RIC SCT.

Medium-term results of neoadjuvant systemic chemotherapy using irinotecan, 5-fluorouracil, and leucovorin in patients with locally advanced rectal cancer

AIMS

The aim of this study was to evaluate the usefulness of neoadjuvant systemic chemotherapy using irinotecan, 5-FU, and leucovorin (LV) for the treatment of locally advanced rectal cancer, which was a powerful ploychemotherapy in those days in Japan.

METHODS

Between 2001 and 2004, 26 patients with T3 or T4 and N0-2 non-metastatic resectable rectal cancer were selectively enrolled in this study. Neoadjuvant chemotherapy consisted of two cycles of irinotecan (80 mg/m²), 5-FU (500 mg/m²), and LV (250 mg/m²) on days 1, 8, and 15 for 4 weeks. Surgical resection was performed in all the patients 2-4 weeks after the completion of chemotherapy.

RESULTS

Overall down-staging was observed in 15 patients. T level and N level down-staging were observed in 12 and 13 patients, respectively. A pathological complete response was observed in one patients. The median follow-up period was 75 months (range, 8-97 months). Recurrences occurred in 5 patients including pelvic relapses in 3 and distant metastases in 2. The 5-year relapse-free and overall survival rates were 74% and 84%, respectively.

CONCLUSIONS

Neoadjuvant systemic chemotherapy comprised of a combination of multi-drugs as irinotecan, 5-FU, and LV may be beneficial to the prognoses of patients with locally advanced rectal cancer.

Comparison of epicardial, abdominal and regional fat compartments in response to weight loss

BACKGROUND AND AIMS

Echocardiographic measurement of epicardial fat (EF) seems to be a reliable and diagnostic marker of visceral adipose tissue (VAT). However, the weight loss-induced changes in EF have not been compared with those in VAT or the truncal depot. In this study, we aimed to compare the weight loss-induced changes in EF, VAT and other regional fat compartments in obese men.

METHODS AND RESULTS

In this study, 27 moderately obese men (age 45.8+/-1.7 years; body mass index 30.5+/-0.7 kg/m(2)) followed a daily low-calorie diet as part of a clinical 12-week weight loss interventional study. We evaluated the EF thickness by transthoracic echocardiography, assessed the abdominal fat tissues by computed tomography scans, and examined the regional and whole body fat compartments by dual X-ray absorptiometry. An average decrease of 26.8% in the initial calorie intake corresponded to post-program reductions of 17.2%, 11.0%, 16.6%, and 29.8% in EF thickness (P<0.001), body mass, percentage fat mass, and abdominal fat compartments, respectively. The percentage change in VAT in response to weight loss was twice as high as the substantial change in EF tissue (P<0.001).

CONCLUSION

The results of the study suggest that a low-calorie diet-induced weight loss decreases EF thickness. Moderate diet-induced weight loss alone may represent an effective nonpharmacological strategy for reducing EF, which is a unique, pathogenic fat depot and an emerging marker of VAT.

Direct density measurement of shock-compressed iron using hard x rays generated by a short laser pulse

We present the application of short-pulse laser-driven hard x rays (>40 keV) for the direct density measurement of iron compressed by a laser-driven shock. By using an on-shot calibration of the spectral absorption, we are able to obtain line densities with 5%-10% precision, although the x-ray source is not monochromatic. We also discuss possibilities for increasing the precision, which would be an improvement for equation of state measurements.

Performance enhancement of semiconductor devices by control of discrete dopant distribution

As semiconductor devices are scaled down to the nanometre level, random dopant fluctuation in the conducting channel caused by the small number of dopant atoms will significantly affect device performance. We fabricated semiconductor devices with random discrete dopant distribution in the drain side and then evaluated how well we could control the drain current of the devices. The results showed that the drain current in devices with the dopant distribution in the drain side was several per cent higher than that in devices with the dopant distribution in the source side. We believe that this increase in current is caused by the suppression of injection velocity degradation in the source side. The capability to control the location of individual dopant atoms enhances drain current and, therefore, the performance of nanodevices. Accurately controlling both the amount and the positioning of dopant atoms is critical for the advancement of true nanoelectronics.