Coffee but not green tea consumption is associated with prevalence and severity of hepatic steatosis: the impact on leptin level

BACKGROUND/OBJECTIVES

Most of the studies that have investigated the association between coffee consumption and hepatic steatosis have been experimental and small-scale clinical studies. As a result, epidemiological studies are scarce. To clear the association, we conducted a cross-sectional study and investigated the effects of coffee consumption with those of green tea consumption.

SUBJECTS/METHODS

We analyzed 1024 Japanese male workers. The diagnosis of hepatic steatosis was based on ultrasonography. We divided coffee and green tea consumption into the following three categories: non-drinker; 1-2 cups/day and ⩾3 cups/day. To investigate the association between hepatic steatosis and coffee or green tea consumption, we calculated the odds ratio (OR) and adjusted the means of leptin levels on each severity of hepatic steatosis.

RESULTS

A total of 265 of our subjects (25.9%) were diagnosed with hepatic steatosis. The ORs of the group of subjects who drank >3 cups of coffee/day was significantly lower compared with that of the noncoffee drinker group (OR 0.59, 95% confidence intervals 0.38-0.90, P=0.03). Although there was a significant difference between coffee consumption and leptin level only in the asymptomatic group, we found a decreasing trend in the asymptomatic and moderate-severe hepatic steatosis group. We did not find the same relationships in green tea consumption.

CONCLUSIONS

Although we did not find an association between hepatic steatosis and green tea consumption, coffee may have beneficial effects on hepatic steatosis. In addition, we produced one possible hypothesis that coffee consumption negatively associates with leptin levels in hepatic steatosis.

Influence of Light Intensity on Surface Free Energy and Dentin Bond Strength of Core Build-up Resins

Objective

We examined the influence of light intensity on surface free energy characteristics and dentin bond strength of dual-cure direct core build-up resin systems.

Methods

Two commercially available dual-cure direct core build-up resin systems, Clearfil DC Core Automix with Clearfil Bond SE One and UniFil Core EM with Self-Etching Bond, were studied. Bovine mandibular incisors were mounted in acrylic resin and the facial dentin surfaces were wet ground on 600-grit silicon carbide paper. Adhesives were applied to dentin surfaces and cured with light intensities of 0 (no irradiation), 200, 400, and 600 mW/cm2. The surface free energy of the adhesives (five samples per group) was determined by measuring the contact angles of three test liquids placed on the cured adhesives. To determine the strength of the dentin bond, the core build-up resin pastes were condensed into the mold on the adhesive-treated dentin surfaces according to the methods described for the surface free energy measurement. The resin pastes were cured with the same light intensities as those used for the adhesives. Ten specimens per group were stored in water maintained at 37°C for 24 hours, after which they were shear tested at a crosshead speed of 1.0 mm/minute in a universal testing machine. Two-way analysis of variance (ANOVA) and a Tukey-Kramer test were performed, with the significance level set at 0.05.

Results

The surface free energies of the adhesive-treated dentin surfaces decreased with an increase in the light intensity of the curing unit. Two-way ANOVA revealed that the type of core build-up system and the light intensity significantly influence the bond strength, although there was no significant interaction between the two factors. The highest bond strengths were achieved when the resin pastes were cured with the strongest light intensity for all the core build-up systems. When polymerized with a light intensity of 200 mW/cm2 or less, significantly lower bond strengths were observed.

Conclusions

The data suggest that the dentin bond strength of core build-up systems are still affected by the light intensity of the curing unit, which is based on the surface free energy of the adhesives. On the basis of the results and limitations of the test conditions used in this study, it appears that a light intensity of >400 mW/cm2 may be required for achieving the optimal dentin bond strength.

Phase II trial of combination therapy of gemcitabine plus anti-angiogenic vaccination of elpamotide in patients with advanced or recurrent biliary tract cancer

Background Elpamotide is an HLA-A*24:02-restricted epitope peptide of vascular endothelial growth factor receptor 2 (VEGFR-2) and induces cytotoxic T lymphocytes (CTLs) against VEGFR-2/KDR. Given the high expression of VEGFR-2 in biliary tract cancer, combination chemoimmunotherapy with elpamotide and gemcitabine holds promise as a new therapy. Patients and Methods Patients with unresectable advanced or recurrent biliary tract cancer were included in this single-arm phase II trial, with the primary endpoint of overall survival. Survival analysis was performed in comparison with historical control data. The patients concurrently received gemcitabine once a week for 3 weeks (the fourth week was skipped) and elpamotide once a week for 4 weeks. Results Fifty-five patients were registered, of which 54 received the regimen and were included in the full analysis set as well as the safety analysis set. Median survival was 10.1 months, which was longer than the historical control, and the 1-year survival rate was 44.4 %. Of these patients, injection site reactions were observed in 64.8 %, in whom median survival was significantly longer (14.8 months) compared to those with no injection site reactions (5.7 months). The response rate was 18.5 %, and all who responded exhibited injection site reactions. Serious adverse reactions were observed in five patients (9 %), and there were no treatment-related deaths. Conclusion Gemcitabine and elpamotide combination therapy was tolerable and had a moderate antitumor effect. For future development of therapies, it will be necessary to optimize the target population for which therapeutic effects could be expected.

Mechanical Properties and Simulated Wear of Provisional Resin Materials

The purpose of this study was to determine flexural properties and erosive wear behavior of provisional resin materials. Three bis-acryl base provisional resins-1) Protemp Plus (PP), 2) Integrity (IG), 3) Luxatemp Automix Plus (LX)-and a conventional poly(methylmethacrylate) (PMMA) resin, UniFast III (UF), were evaluated. A resin composite, Z100 Restorative (Z1), was included as a benchmark material. Six specimens for each of the four materials were used to determine flexural strength and elastic modulus according to ISO Standard 4049. Twelve specimens for each material were used to examine wear using a generalized wear simulation model. The test materials were each subjected to wear challenges of 25,000, 50,000, 100,000, and 200,000 cycles in a Leinfelder-Suzuki (Alabama) wear simulator. The materials were placed in custom cylinder-shaped stainless-steel fixtures, and wear was generated using a cylindrical-shaped flat-ended stainless-steel antagonist in a slurry of nonplasticized PMMA beads. Wear (mean facet depth [μm] and volume loss [mm(3)]) was determined using a noncontact profilometer (Proscan 2100) with Proscan and AnSur 3D software. The laboratory data were evaluated using two-way analysis of variance (ANOVA; factors: 1) material and 2) cycles) followed by Tukey HSD post hoc test (α=0.05). The flexural strength ranged from 68.2 to 150.6 MPa, and the elastic modulus ranged from 2.0 to 15.9 GPa. All of the bis-acryl provisional resins (PP, IG, and LX) demonstrated significantly higher values than the PMMA resin (UF) in flexural strength and elastic modulus (p<0.05). However, there was no significant difference (p>0.05) in flexural properties among three bis-acryl base provisional resins (PP, IG, and LX). Z1 demonstrated significantly (p<0.05) higher flexural strength and elastic modulus than the other materials tested. The results for mean facet wear depth (μm) and standard deviations (SD) for 200,000 cycles were as follows: PP, 22.4 (5.0); IG, 51.0 (6.5); LX, 63.7 (4.5); UF, 70.5 (8.0); and Z1, 7.6 (1.2). Volume loss (mm(3)) and SDs for 200,000 cycles were as follows: PP, 0.311 (0.049); IG, 0.737 (0.074); LX, 0.919 (0.053); UF, 1.046 (0.127); and Z1, 0.111 (0.017). The two-way ANOVA showed a significant difference among materials (p<0.001) and number of cycles for both facet depth and volume loss. The post hoc test revealed differences (p<0.05) in wear values among the tested materials examined in this study. The findings provide valuable information regarding the flexural properties and the relative wear behavior of the provisional resins examined in this study.

[Post-recurrence survival after surgical resection of non-small cell lung cancer with local recurrence]

We retrospectively evaluated the clinical outcomes of 192 consecutive patients with local recurrence after complete resection of non-small cell lung cancer NSCLC). The initial local recurrent site was the resection stump in 5 patients the chest wall in 3 patients, mediastinum in 1 patient, and diaphragm in 1 patient), and the hilar and/or mediastinal lymph node (HMLN) in 17 patients. The sites of distant metastasis were the lungs in 10 patients, pleura in 4 patients, brain in 7 patients, liver in 5 patients, bone in 4 patients, and other sites in 4 patients. Treatments after initial recurrence included surgery in 2 patients, radiotherapy in 5 patients, chemotherapy in 9 patients, and chemo-radiotherapy in 5 patients. Only 1 patient received supportive care. The response to radiotherapy was a complete response (R) in 1 patient, partial response (PR) in 5 patients, stable disease (SD )in 3 patients, and progressive disease (PD )in 1 patient. The best response of all lines of chemotherapy was CR in 3 patients, PR in 4 patients, SD in 3 patients, and PD in 4 patients. The median post-recurrence survival (PRS) time with local recurrence was better than that with distant metastasis (23 vs 14 months); however, the best PRS was obtained in patients with recurrence in the lungs (29 months). A CR for more than 2 years was obtained in 1 patient after surgery, in 1 patient after radiotherapy, and in 2 patients after chemotherapy. Although local recurrence of resected NSCLC can be potentially controlled by using local treatments - such as surgery and radiotherapy - or systemic chemotherapy, curative aggressive treatment should be considered when required.

Combined vascular resection and reconstruction during hepatobiliary and pancreatic cancer surgery

Prospective studies needed at high-volume centres

Id2 and Id3 maintain the regulatory T cell pool to suppress inflammatory disease

Regulatory T (Treg) cells suppress the development of inflammatory disease, but our knowledge of transcriptional regulators that control this function remains incomplete. Here we show that expression of Id2 and Id3 in Treg cells was required to suppress development of fatal inflammatory disease. We found that T cell antigen receptor (TCR)-driven signaling initially decreased the abundance of Id3, which led to the activation of a follicular regulatory T (TFR) cell-specific transcription signature. However, sustained lower abundance of Id2 and Id3 interfered with proper development of TFR cells. Depletion of Id2 and Id3 expression in Treg cells resulted in compromised maintenance and localization of the Treg cell population. Thus, Id2 and Id3 enforce TFR cell checkpoints and control the maintenance and homing of Treg cells.

Current and emerging MR imaging techniques for the diagnosis and management of CSF flow disorders: a review of phase-contrast and time-spatial labeling inversion pulse

This article provides an overview of phase-contrast and time-spatial labeling inversion pulse MR imaging techniques to assess CSF movement in the CNS under normal and pathophysiologic situations. Phase-contrast can quantitatively measure stroke volume in selected regions, notably the aqueduct of Sylvius, synchronized to the heartbeat. Judicious fine-tuning of the technique is needed to achieve maximal temporal resolution, and it has limited visualization of CSF motion in many CNS regions. Phase-contrast is frequently used to evaluate those patients with suspected normal pressure hydrocephalus and a Chiari I malformation. Correlation with successful treatment outcome has been problematic. Time-spatial labeling inversion pulse, with a high signal-to-noise ratio, assesses linear and turbulent motion of CSF anywhere in the CNS. Time-spatial labeling inversion pulse can qualitatively visualize whether CSF flows between 2 compartments and determine whether there is flow through the aqueduct of Sylvius or a new surgically created stoma. Cine images reveal CSF linear and turbulent flow patterns.

Plasma cytokine profiles related to smoking-sensitivity and phenotypes of chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease (COPD) develops only in smoking-sensitive smokers and manifests heterogeneous phenotypes, including emphysema and non-emphysema types. We aimed to identify biomarkers related to the smoking-sensitivity and phenotypes of COPD. Among 240 smokers suggestive of COPD, we studied on four groups defined by % forced expiratory volume in one second (FEV1) and computed tomography-based pulmonary emphysema. Plasma concentrations of 33 inflammatory markers were measured in four groups as well as Non-smokers using multiplex protein arrays. IL-5, IL-7 and IL-13 were identified to be associated with smoking sensitivity and IL-6 and IL-10 were candidate biomarkers for airway-lesion dominant COPD.

The establishment of B versus T cell identity

In B cell progenitors, E-proteins E2A and HEB (HeLa E-box binding protein) are crucial for the induction of a B lineage-specific program of gene expression and for orchestrating the assembly of the immunoglobulin loci. In the thymus E2A and HEB act differently, activating the expression of genes closely associated with the establishment of T cell identity and promoting the rearrangement of T cell receptor (TCR) loci. These findings have raised the question as to how E-proteins exert these different activities. We review here the distinct regulatory networks that establish B versus T cell identity, and how genomic architecture and location of genes is modulated in these lineage decisions. We conclude by proposing a model wherein stochasticity in the nuclear location of the early B cell factor 1 (Ebf1) locus in multipotent progenitors determines this lineage choice.

Risk factors for hepatocellular carcinoma in hepatitis C patients with normal alanine aminotransferase treated with pegylated interferon and ribavirin

Pegylated interferon (Peg-IFN) plus ribavirin combination therapy is effective in patients with hepatitis C virus (HCV) infection and normal alanine aminotransferase levels (NALT). However, it remains unclear whether the risk of hepatocellular carcinoma (HCC) incidence is actually reduced in virological responders. In this study, HCC incidence was examined for 809 patients with NALT (ALT ≤ 40 IU/mL) treated with Peg-IFN alpha-2b and ribavirin for a mean observation period of 36.2 ± 16.5 months. The risk factors for HCC incidence were analysed by Kaplan-Meier method and Cox proportional hazards model. On multivariate analysis among NALT patients, the risk of HCC incidence was significantly reduced in patients with sustained virological response (SVR) or relapse compared with those showing nonresponse (NR) (SVR vs NR, hazard ratio (HR): 0.16, P = 0.009, relapse vs NR, HR: 0.11, P = 0.037). Other risk factors were older age (≥65 years vs <60 years, HR: 6.0, P = 0.032, 60-64 vs <60 years, HR: 3.2, P = 0.212) and male gender (HR: 3.9, P = 0.031). Among 176 patients with PNALT (ALT ≤ 30 IU/mL), only one patient developed HCC and no significant risk factors associated with HCC development were found. In conclusion, antiviral therapy for NALT patients with HCV infection can lower the HCC incidence in responders, particularly for aged and male patients. The indication of antiviral therapy for PNALT (ALT ≤ 30 IU/mL) patients should be carefully determined.

Effect of Pre-reacted Glass-ionomer Filler Extraction Solution on Demineralization of Bovine Enamel

Objective

To determine the effect of pre-reacted glass-ionomer (PRG) filler extraction solution on the demineralization of bovine enamel by measuring changes in the ultrasound transmission velocity.

Methods

The specimens were prepared by cutting bovine teeth into enamel blocks. The specimens were immersed in buffered lactic acid solution for 10 minutes twice a day, and then stored in artificial saliva. Other specimens were stored in PRG filler extraction solution for 10 minutes, followed by 10-minute immersion in the buffered lactic acid solution twice a day. The propagation time of longitudinal ultrasonic waves was measured by a pulser receiver. Six specimens were used for each condition, and analyses of variance followed by Tukey tests (α=0.05) were done.

Results

No changes in sonic velocity were found for specimens stored in the PRG filler extraction solution, indicating that the PRG extraction solution had an effect on inhibiting the demineralization of bovine enamel.

Conclusions

The results obtained with the use of an ultrasound measurement technique suggested that PRG filler extraction solution has the ability to prevent demineralization of enamel.

Proposal to modify the International Union Against Cancer staging system for perihilar cholangiocarcinomas

BACKGROUND

The International Union Against Cancer (UICC) staging system for perihilar cholangiocarcinoma changed in 2009. The aim of this study was to validate and optimize the UICC system for these tumours.

METHODS

This retrospective study was conducted in eight Japanese hospitals between 2001 and 2010. Perihilar cholangiocarcinoma was defined as a cholangiocarcinoma that involves the hilar bile duct, independent of the presence or absence of a liver mass component. The stratification ability of the UICC tumour node metastasis (TNM) system was compared with that of a modified system.

RESULTS

Of 1352 patients, 35.9, 44.8 and 12.6 per cent had Bismuth type IV tumours, nodal metastasis (N1) and distant metastasis (M1) respectively. T4 tumours (43.2 per cent) and stage IVA (T4 Nany M0; 36.3 per cent) disease were most common. Survival was not significantly different between patients with T3 versus T4 tumours (P = 0.284). Survival for patients with stage IVA disease was comparable to that for patients with stage IIIB tumours (T1-3 N1 M0) (P = 0.426). Vascular invasion, pancreatic invasion, positive margin, N1 and M1 status were identified as independent predictors of survival. When Bismuth type IV tumours were removed from the T4 determinants and N1 tumours grouped together, the modified grouping had a higher linear trend χ2 and likelihood ratio χ2 compared with the original system (245.6 versus 170.3 respectively and 255.8 versus 209.3 respectively).

CONCLUSION

The present data suggest that minimal modification with removal of Bismuth type IV tumours from the T4 determinants and bundling of N1 disease may enhance the prognostic ability of the UICC system. However, this requires validation on an independent data set.

Analysis of comorbid factors that increase the COPD assessment test scores

BACKGROUND

The chronic obstructive pulmonary disease (COPD) Assessment Test (CAT) is a concise health status measure for COPD. COPD patients have a variety of comorbidities, but little is known about their impact on quality of life. This study was designed to investigate comorbid factors that may contribute to high CAT scores.

METHODS

An observational study at Keio University and affiliated hospitals enrolled 336 COPD patients and 67 non-COPD subjects. Health status was assessed by the CAT, the St. Georges Respiratory Questionnaire (SGRQ), and all components of the Medical Outcomes Study Short-Form 36-Item (SF-36) version 2, which is a generic measure of health. Comorbidities were identified based on patients' reports, physicians' records, and questionnaires, including the Frequency Scale for the Symptoms of Gastro-esophageal reflux disease (GERD) and the Hospital Anxiety and Depression Scale. Dual X-ray absorptiometry measurements of bone mineral density were performed.

RESULTS

The CAT showed moderate-good correlations with the SGRQ and all components of the SF-36. The presence of GERD, depression, arrhythmia, and anxiety was significantly associated with a high CAT score in the COPD patients.

CONCLUSIONS

Symptomatic COPD patients have a high prevalence of comorbidities. A high CAT score should alert the clinician to a higher likelihood of certain comorbidities such as GERD and depression, because these diseases may co-exist unrecognized.

TRIAL REGISTRATION

Clinical trial registered with UMIN (UMIN000003470).

Abstract P3-13-08: A phase I study of weekly nab-paclitaxel in combination with S-1 in patients with metastatic breast cancer

Background: S-1 is an oral, fixed dose combination product comprised of tegafur, a fluoropyrimidine prodrug of 5-fluorouracil (5-FU), and modulators of 5-FU metabolism, 5-chloro-2.4-dihydrooxypyridine and oteracil potassium. S-1 is designed to provide oral delivery of 5-FU, a pyrimidine analog antimetabolite antineoplastic agent, while reducing the rate of degradation of 5-FU and its conversion in the gastrointestinal tract to its toxic phosphorylated metabolite. S-1 is active in breast cancer and a variety of solid tumors. nab™-Paclitaxel (nab-P) is a treatment option in metastatic breast cancer (MBC) (approved 260 mg/m2 q3w dosing schedule), and high activity of nab-P with single-agent weekly administration at 100 mg/m2 has been investigated in MBC as well as other disease states. Since these two agents differed in their mechanisms of action and toxicity profiles, we sought to test their combined activity in a phase I study of nab-P/S-1 for HER2-negative MBC. The primary objectives of this study was to determine the maximum tolerated dose (MTD) and recommended dose (RD) of nab-P/S-1 in patients with HER-2 negative MBC. The secondary objective of this study was to evaluate pharmacokinetic (PK) parameters of both agents.

Methods: Patients received treatment on 3 week cycles. S-1 was administered orally at a twice-daily dose of 65 mg/m2 (dose level 1 and 2b) or 80 mg/m2 (dose level 2a and 3) for 14 days and nab-P was administered as a 30-minute IV infusion at a dose of 100 mg/m2 on days 1 and 8 (dose level 1 and 2b) or 100 mg/m2 on days 1, 8 and 15 (dose level 2a and 3).

Results: Fifteen patients were enrolled in this study; nab-P/S-1 was given as first-line chemotherapy for MBC in 9 patients, and as second-line therapy subsequent to an anthracycline-containing therapy in 6 patients. At dose level 3, one patient experienced a DLT. The observed DLT was delay of initiation of next cycle, G4 neutropenia had not recovered to G1/G0 in a period defined on the protocol. No cases of febrile neutropenia were observed. Judged from the status of dose reduction and the extension of drug holidays (cycle start delay), and the occurrence of non-severe adverse events after 2 cycles, the dose level was not increased above level 3. Seven patients were able to be treated 10 cycles or more. Additionally, three patients were able to be treated 20 cycles or more. Among of the 12 patients who had a measurable lesion which was evaluable by RECISTv1.1, the overall response rate was 50%, with 1 CR, 5 PR, 4 SD, and 1 PD. Pharmacokinetics of Paclitaxel and 5-FU in the combination therapy were comparable to those after single-agent administration of nab-P and S-1, respectively.

Conclusion: Based on the results of this study, the RD was determined to be dose level 3 (S-1 80 mg/m2 twice daily plus nab-P 100 mg/m2 on days 1, 8, and 15). Since this combination therapy was generally well tolerated even with prolonged treatment, it is suggested that this combination therapy may be a promising treatment regimen in HER-2 negative MBC and merits further evaluation.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P3-13-08.

[A case of small-sized lung cancer complicated by sarcoidosis]

A woman in her seventies presented with bilateral hilar and mediastinal lymphadenopathy with high fluorodeoxyglucose (FDG) uptake by positron emission tomography (PET)-computed tomography (CT), small lung nodules, and uveitis. Mediastinoscopic biopsy yielded a histological finding of epithelioid granuloma and a diagnosis of sarcoidosis. A nodule, 1 cm in diameter, in the right middle lobe with moderate FDG uptake was deemed to be a sarcoidosis lesion. Steroid therapy for uveitis resulted in shrinkage of the hilar and mediastinal lymph nodes; however, 1 year later the nodule in the right middle lobe had enlarged to 2 cm in diameter. Right middle lobectomy was performed, and a histological diagnosis of lung squamous cell carcinoma was made. Six months later, right pretracheal lymphadenopathy with high FDG uptake was noted and was proved to be a metastatic squamous cell carcinoma by endobronchial ultrasound-guided transbronchial needle aspiration( EBUS-TBNA). After 7 courses of chemotherapy with docetaxel, the target lesion shrank and its abnormal FDG uptake disappeared. Small-sized lung cancer could be missed when complicated by sarcoidosis because the latter produces a background of multiple lesions, so careful diagnostic imaging and follow-up should be performed in patients diagnosed as having sarcoidosis.