Inter-rater reliability of proxy simple symptom assessment scale between physician and nurse: a hospital-based palliative care team setting

Symptom management in palliative care requires reliable symptom assessment. We assessed the inter-rater reliability of a simple proxy symptom-assessment scale using the Japanese version of the Support Team Assessment Schedule (STAS-J) in a hospital-based palliative care team (HPCT) setting. By doing this, we assessed symptoms in a series of consecutive patients at two university hospitals with certified HPCTs within 2 days of referral and 7 days after. A physician and nurse assessed 20 symptoms. In total, 120 patients were assessed within 2 days of referral and 92 patients at 7 days after referral. As a result, we find that the intra-class correlation coefficients were 0.02-0.89 at referral and 0.20-0.92 at 7 days after. The perfect concordance rates were 37-89% at referral and 53-96% at 7 days after. The perfect or +/-1 concordance rates were 71-97% at referral and 73-100% at 7 days after. In conclusion, the symptom item of the STAS-J had high inter-rater reliability.

Differential mitochondrial scoring associated with chemotherapeutic effect on ovarian cancer

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Background: We reported mitochondrial (MT) scoring system related to platinum response in ovarian cancer (OC) (Oncol Rep2008). We investigated whether the system could be useful to evaluate cellular drug sensitivity and patients’ prognosis. Methods: Ultrathin sections of surgical specimens prepared from 41 OC patients were examined by electron microscopy. Ovarian carcinoma cell line 2008 and its platinum- or taxane-resistant variant C13 or PX24 were used as control cells. Seven independent MT features including diameter and pattern of cresta structure were examined. Clinical response and in vitro sensitivity to platinum (P), taxane (T), irrinotecan (CPT), and doxorubicine (D) were examined while the MT scoring was performed independently. Results: Of 41 cases, 37 were available for clinical evaluation (stage II-IV, received 6 cycles of TP chemotherapy). Fifteen cases were responsive, while 22 were resistant. Total MT score in 15 responsive cases was 5.13 ± 1.13 (M ± SE) and was 11.41 ± 0.43 in 22 resistant cases (p < 0.001). Receptor operative characteristics (ROC) analysis revealed that resistant total “cut-off” score was ≥ 10 points (p < 0.05; AUC = 0.86). Except for D, the scoring system well related to P, T, and CPT sensitivity (p; <0.001, <0.001, 0.006). ROC analysis revealed resistant “cut-off” score for P, T and CPT were ≥ 11, 5, and 10 points (p < 0.05; AUC > 0.80). With a median follow up of 20 months, 11 patients have relapsed. The progression-free survival (PFS) curves show a difference in favor of low scoring group of patients (N = 14) compared to high scoring group (N = 19) (hazard ratio 3.99, p = 0.045), corresponding to an absolute difference in 6-months PFS 16% (89 vs 73%). Conclusions: This MT scoring system excellently related to clinically diagnosed P sensitivity as well as cellular sensitivity to P, T and CPT. Each drug has its own specific “cut-off” score, suggesting that the MT function might be differentially involved in drug sensitivity.

No significant financial relationships to disclose.

Genotyping of Strawberry (Fragaria ananassa Duch.) Cultivars by DNA Markers: Interlaboratory Study

Fourteen Japanese laboratories validated the reproducibility of genotyping by 25 cleavage amplified polymorphic sequence (CAPS) markers for discrimination of strawberry (Fragaria ananassa Duch.) cultivars. Both the sensitivity and specificity rate of 12 markers were 100, those of another 12 were &gt;95, and those of 1 were &gt;90. These results indicate that the method of genotyping by the CAPS markers was highly reproducible and could provide a useful basis for practical identification of strawberry cultivars. This is the first report of the statistical validation of crop genotyping by DNA markers.

Local VEGF administration enhances healing of colonic anastomoses in a rabbit model

BACKGROUND/AIMS

Many studies report the role of vascular endothelial growth factor (VEGF) in wound healing, but few describe local VEGF administration to the digestive tract. Leakage from colonic anastomoses, including those due to ischemia, represents a major complication causing increased mortality and morbidity. Angiogenesis is crucial to anastomotic healing and restoration of blood supply, and VEGF is a potent angiogenic factor showing improved healing in various models of reconstruction and anastomosis. Here, we examine the effects of local VEGF-A(165) administration on postoperative rabbit colon anastomosis.

METHODS

Two colotomies per animal were made in the sinistral colon on opposite sides of the mesentery. Randomly assigned VEGF (10 microg/0.1 ml) or saline (0.1 ml) was injected into the muscularis propria on both sides of each colonic anastomosis before closing the access laparotomy using single-layer sutures. On postoperative days 3, 4 and 7, the bursting pressure of partially healed anastomoses was measured. On postoperative day 4, anastomotic tissues were examined for the following: hydroxyproline; histopathologically for inflammatory infiltrate and tissue organization and immunohistochemically for capillary proliferation and density; vessel density of midzone collaterals around anastomoses by microangiography.

RESULTS

Compared to saline, VEGF administration significantly improved bursting pressure (p = 0.014, paired t test) and increased hydroxyproline (p = 0.027, paired t test) on postoperative day 4. Inflammatory cell infiltration and fibroblast proliferation were prominent, and submucosal capillary vascular counts were significantly higher for VEGF.

CONCLUSIONS

Administration of VEGF to colonic anastomosis accelerates wound healing and strengthens the anastomosis by increased angiogenesis.

Effect of interleukins response to ECM-induced acquisition of drug resistance in MCF-7 cells

AIM

To examine the effect of various components of extracellular matrix (ECM) on acquisition of drug resistance to taxol and camptothecin by breast carcinoma cell line MCF-7.

METHODS

Cancer cells were cultured on bovine serum albumin (BSA), vitronectin (VN), fibronectin (FN), collagen type I (COL-I), or Matrigel-coated plates with or without taxol (paclitaxel) or camptothecin treatment. The effect of anticancer drugs on cell growth was accessed by XTT assay, and the alterations of cellular morphology were examined by phase contrast microscopy. Immunofluorescence study was performed using monoclonal anti-beta-tubulin antibody.

RESULTS

All cell lines showed a significant decrease in cell survival when treated with anticancer drugs without components of ECM, whereas survival rates of Caco-2, MCF-7 and NCI-H292 were significantly increased when cells were cultured on COL-I- and Matrigel-coated dishes after treatment with paclitaxel or camptothecin. MCF-7 cells showed and maintained a colony formation when cultured on the COL-I- and Matrigel-coated dish. Moreover, cytotoxicity (IC50) was decreased by taxol (paclitaxel) or camptothecin treatment during colony formation in MCF-7 cells, suggesting that morphological changes could increase survival of cells treated with anticancer drugs. Thick circumferential bundles of microtubules around the periphery of the cells and chromatin condensation was not observed for MCF-7 cells on COL-I- and Matrigel-coated dishes treated with paclitaxel. To confirm this, spheroid cells were prepared, and we found that cytotoxicity was decreased for these cells, and significantly increased when cells were co-cultured on Matrigel- or COL-I-coated upper wells. The effect of anticancer drugs on cell survival was efficiently inhibited by interleukin-6 (IL-6) and interleukin-8 (IL-8).

CONCLUSIONS

Present results suggested that not only integrin-ECM interactions but also other factors such as IL-6and IL-8secreted by cancer cells, cultured on COL-I and Matrigel dishes, are involved in the acquisition of drug resistance by MCF-7.

Purine contents of soybean-derived foods and selected Japanese vegetables and mushrooms

Purine contents of soybean-derived food and various other Japanese foods were quantitatively determined by high-performance liquid chromatography (HPLC). Purine contents were as follows: soybean-derived foods, 21.9-172.5 mg/100 g or 100 mL; Japanese vegetables, 2.3-171.8 mg/100 g; Japanese mushrooms, 9.5-142.3 mg/100 g. Since purine levels in these foods did not exceed 200 mg/100 g, we recommend that eating of them should be adopted and good dietary habits followed.

T-even-related bacteriophages as candidates for treatment of Escherichia coli urinary tract infections

Multidrug-resistant uropathogenic Escherichia coli (UPEC) is increasing gradually on a worldwide scale. We therefore examined the possibility of bacteriophage (phage) therapy for urinary tract infections (UTIs) caused by the UPEC strains as an alternative to chemotherapy. In addition to the well-known T4 phage, KEP10, which was newly isolated, was used as a therapeutic phage candidate. KEP10 showed a broader bacteriolytic spectrum (67%) for UPEC strains than T4 (14%). Morphological and genetic analyses showed that KEP10 resembles phage T4. Phages T4 and KEP10 injected into the peritoneal cavity of mice were distributed immediately to all organs examined and maintained a high titer for at least 24 h. They were stable in the urine of both mice and humans for 24 h at 37 degrees C. Administration of these phages into the peritoneal cavity caused a marked decrease in the mortality of mice inoculated transurethrally with a UPEC strain, whereas most of the control mice died within a few days of bacterial infection. Inoculation with phage alone produced no adverse effects attributable to the phage per se. The present study experimentally demonstrated the therapeutic potential of phage for E. coli-induced UTIs, and T-even-related phages may be suitable candidates with which to treat them.

Secondary T790M mutation and novel G796A mutation in exon20 of EGFR gene in patients with non-small cell lung cancer who show resistance to gefitinib

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Background: Somatically acquired mutations in the EGFR gene in non-small cell lung cancer are associated with a significant clinical response to a tyrosine kinase inhibitor (TKI). EGFR mutations occur predominantly in exon19 and/or exon21, namely, an in-frame deletion in exon19 or a missense mutation in exon21 (L858R), which have been found to be related to the sensitivity to TKI. However, most patients with such sensitive mutations in their tumor show progression during the TKI treatment. In such resistant tumors, a secondary threonine- to-methionine mutation at codon 790 (T790M) in exon20 has been reported to be related the resistance to either gefitinib or erlotinib. Methods: EGFR mutations in exons19–21 were examined by sequencing in 37 pretreatment tumors obtained from patients with NSCLC, who were treated by gefitinib. Of the 22 cases having sensitive EGFR mutations (19del or L858R), 15 showed CR/PR and 7 showed SD/PD. Of the 15 patients with CR/PR, 4 tumor samples (2 lung, 1 liver, and 1 pleural effusion) that became refractory to gefitinib, were obtained. In pretreatment tumor samples from 4 patients, an in-frame deletion of exon19 was observed in 3 tumors and a L858R mutation of exon21 was in 1 tumor. We next examined whether a secondary mutation occurred in a tumor with acquired resistance to gefitinib in 4 patients by the sequencing of exons 19–21, with informed consent. Results: Three of 4 tumor samples had a secondary T790M mutation, which was not detected in the pretreatment tumor samples. These 3 samples also had an in-frame deletion in exon19. There were no other novel secondary mutations in exons 19,20,21. In 7 cases showing resistance to gefitinib (SD/PD) in spite of the existence of sensitive mutations, 1 tumor demonstrated the co-existence of a missense mutation (G796A) in exon20. In vitro, a stable clone of cells bearing the G796A mutation was approximately 50,000-fold less sensitive to gefitinib in comparison to the cells carrying exon19 deletion. Conclusions: The T790M mutation is common in patients with acquired resistance to gefitinb. Our results suggest that screening tumor samples for a range of EGFR mutations may therefore improve our ability to identify the patients most likely to benefit from treatment with TKI.

No significant financial relationships to disclose.

A prospective phase II study of gefitinib in non-small cell cancer patients with epidermal growth factor receptor gene (EGFR) mutations

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Background: Somatically acquired mutations in the EGFR gene in non-small cell lung cancer are associated with a significant clinical response to gefitinib, a tyrosine kinase inhibitor that targets EGFR, especially in patients with adenocarcinoma, females, and/or never/light smokers. In our retrospective study, cases with EGFR mutations (exon19del or L858R) showed a high sensitivity to gefitinib, and the patients with sensitive EGFR mutations also tended to have a more favorable prognosis than those with wild-type after gefitinib treatment (Uramoto, et al. Lung Cancer 2006;51:71). In the present study, we prospectively assessed the efficacy of gefitinib and the survival benefit for patients with EGFR mutations. Methods: Patients with either recurrent disease after undergoing surgery or advanced disease (IIIB or IV) of NSCLC which demonstrated EGFR mutations were eligible for this study. EGFR mutations in exons 19–21 were examined by our previously described screening method (Sugio, et al. Br J Cancer 2006;94:896) and confirmed by direct sequencing after informed consent was obtained from all patients. The patients with EGFR mutations were enrolled in this study after obtaining informed consent a second time, and they were thereafter treated with gefitinib. Results: Between 2005 and 2006, 16 patients (10 males/6 females, all adenocarcinoma) who had EGFR mutations were enrolled onto this study. Six pts had a deletion in exon 19, 8 pts had a missense mutation in exon 21 (L858R), 1 pt had both an exon 19 del and L858R, and 1 pts had an exon19 del and missense mutation in exon 20 (G796A). The overall response rate was 50%, and the disease control rate was 88%. In patients with exon19 del and L858R, the response rates were 83% and 25%, respectively. A case with a deletion in exon19 and a missense mutation in exon20 (G796A) showed resistance to gefitinib. The median progression-free survival time was 8.8 months, and the median survival time was 15.4 months. No life-threatening toxicity was observed. Conclusions: EGFR mutations in exons 19 or 21 are therefore considered to a good predictor of the efficacy of gefitinib, and the treatment with gefitinib was also found to achieve a prolonged survival.

No significant financial relationships to disclose.

Laboratory studies on nitrogen and phosphorus removal from swine wastewater by iron electrolysis

Biological process-free ("Bio-free") treatment of swine wastewater (pH 8.5 or above) for the removal of nitrogen and phosphorus was examined. In this study centrifugal separation of solids and liquids was followed by iron electrolysis, which enables removal of nitrogen and phosphorus when iron is set as the cathode and anode, respectively. The manner in which the treatment efficiency varies according to the current ratio of iron anode to iron cathode (Rac) was investigated. Nitrogen was removed to a level below 60 mg l(-1) in a 3-h treatment when Rac was above 75% and phosphorus was removed to a level below 8 mg l(-1) in the same period, irrespective of Rac. Nitrogen removal efficiency was 60 kWh kg-N(-1) , which is 6 times higher than that of the same electrolytic treatment when used after aerobic biological treatment ("Post-bio").

F-18 fluorodeoxyglucose uptake in leiomyomatous uterus

Leiomyomas of uterus are common disease in gynecology. It is important to differentiate leiomyoma from leiomyosarcoma at the decision of treatment methods, especially in the case of the conservative treatment for uterine leiomyoma. But the exact diagnosis of benign leiomyoma is often difficult due to the degeneration of myoma by imaging modalities including magnetic resonance imaging. Recently, whole-body positron emission tomography (PET) using F-18 fluorodeoxyglucose (FDG) has been used for a diagnosis of malignant tumors. There is a growing body of evidence for the use of FDG in differentiating malignant from benign disease. But optimal utilization in gynecology remains unclear. Our case represents increased uptake of FDG in myomatous uterus, which is pathologically confirmed benign leiomyoma by the hysterectomy. Immunohistochemical analysis of glucose transporter-1 showed positive in endometrial tissue and negative in leiomyoma. Our case indicates that myomatous uterus in premenopausal women shows the potential pitfall of a positive result of FDG-PET.

Clinical and genetic features of families with frontotemporal dementia and parkinsonism linked to chromosome 17 with a P301S tau mutation

In 9 patients with frontotemporal dementia and parkinsonism linked to chromosome 17 (FTDP-17) with a P301S tau mutation, the predominant phenotype was frontotemporal dementia in 3 and parkinsonism in 6. Comparison of the tau genotype/haplotype carrying the mutation and the initial clinical sign showed association between H1/H1 and parkinsonism and between H1/H2 and personality change. Thus, the tau haplotype carrying the mutation and the tau genotype may be related to the clinical phenotype throughout the disease course.