Associations of conservatism and jumping to conclusions biases with aberrant salience and default mode network

AIM

While conservatism bias refers to the human need for more evidence for decision-making than rational thinking expects, the jumping to conclusions (JTC) bias refers to the need for less evidence among individuals with schizophrenia/delusion compared to healthy people. Although the hippocampus-midbrain-striatal aberrant salience system and the salience, default mode (DMN), and frontoparietal networks ("triple networks") are implicated in delusion/schizophrenia pathophysiology, the associations between conservatism/JTC and these systems/networks are unclear.

METHODS

Thirty-seven patients with schizophrenia and 33 healthy controls performed the beads task, with large and small numbers of bead draws to decision (DTD) indicating conservatism and JTC, respectively. We performed independent component analysis (ICA) of resting functional magnetic resonance imaging (fMRI) data. For systems/networks above, we investigated interactions between diagnosis and DTD, and main effects of DTD. We similarly applied ICA to structural and diffusion MRI to explore the associations between DTD and gray/white matter.

RESULTS

We identified a significant main effect of DTD with functional connectivity between the striatum and DMN, which was negatively correlated with delusion severity in patients, indicating that the greater the anti-correlation between these networks, the stronger the JTC and delusion. We further observed the main effects of DTD on a gray matter network resembling the DMN, and a white matter network connecting the functional and gray matter networks (all P < 0.05, family-wise error [FWE] correction). Function and gray/white matter showed no significant interactions.

CONCLUSION

Our results support the novel association of conservatism and JTC biases with aberrant salience and default brain mode.

Functional coupling between auditory memory and verbal transformations

The ability to parse sound mixtures into coherent auditory objects is fundamental to cognitive functions, such as speech comprehension and language acquisition. Yet, we still lack a clear understanding of how auditory objects are formed. To address this question, we studied a speech-specific case of perceptual multistability, called verbal transformations (VTs), in which a variety of verbal forms is induced by continuous repetition of a physically unchanging word. Here, we investigated the degree to which auditory memory through sensory adaptation influences VTs. Specifically, we hypothesized that when memory persistence is longer, participants are able to retain the current verbal form longer, resulting in sensory adaptation, which in turn, affects auditory perception. Participants performed VT and auditory memory tasks on different days. In the VT task, Japanese participants continuously reported their perception while listening to a Japanese word (2- or 3-mora in length) played repeatedly for 5 min. In the auditory memory task, a different sequence of three morae, e.g., /ka/, /hi/, and /su/, was presented to each ear simultaneously. After some period (0-4 s), participants were visually cued to recall one of the sequences, i.e., in the left or right ear. We found that delayed recall accuracy was negatively correlated with the number of VTs, particularly under 2-mora conditions. This suggests that memory persistence is important for formation and selection of perceptual objects.

Quantitative assessment of urinary equol levels, equol-producing bacteria, and the faecal microbiota in healthy Japanese individuals

Equol (4',7-isoflavandiol) has attracted considerable attention for its potential efficacy in treating hormonal diseases. In this study we collected samples from healthy Japanese individuals (n = 91) to observe the relationship between the abundance of equol-producing bacteria in their faeces and the concentration of equol in their urine. Quantitative polymerase chain reaction (qPCR) targeting the dihydrodaidzein reductase gene (dhdr) was used to detect equol-producing bacteria. Equol producers, who were defined as individuals with >1000 nmol/l equol in their urine, exhibited 4-8 log10 copies of dhdr/g faeces of equol-producing bacteria. We assessed the accuracy of these findings by determining the rate of correspondence between possessing equol-producing bacteria and producing urinary equol. Of the 91 participants, 33 were found to be positive for both equol-producing bacteria and urinary equol, 52 were negative for both, one was positive for equol-producing bacteria and negative for urinary equol, and five were negative for equol-producing bacteria and positive for urinary equol. The sensitivity and specificity of the qPCR for detecting equol-producing bacteria were 86.8% and 98.1%, respectively. On the whole, the presence of equol-producing bacteria and urinary equol displayed 93.4% concordance, with a kappa coefficient of 0.862. No apparent correlation was observed between dhdr copy number in the faeces and urinary equol concentrations. Analysis of the faecal microbiota showed that alpha diversity indices (OTU, ACE, Chao1, Shannon) were significantly higher in equol producers. Specifically, the relative abundance of phylum Pseudomonadota was increased in non-equol producers, while abundance of genus Alistipes, Barnesiella, Butyricimonas, Odoribacter, and Ruminococcus, which produce short chain fatty acids and/or hydrogen, were only observed in equol producers. These results suggest that a certain amount of equol-producing bacteria must be present in the intestine to produce detectable levels of equol, and that equol productivity might be affected by other components of the microbiota.

Dynamic Transitions Between Brain States Predict Auditory Attentional Fluctuations

Achievement of task performance is required to maintain a constant level of attention. Attentional level fluctuates over the course of daily activities. However, brain dynamics leading to attentional fluctuation are still unknown. We investigated the underlying mechanisms of sustained attention using functional magnetic resonance imaging (fMRI). Participants were scanned with fMRI while performing an auditory, gradual-onset, continuous performance task (gradCPT). In this task, narrations gradually changed from one to the next. Participants pressed a button for frequent Go trials (i.e., male voices) as quickly as possible and withheld responses to infrequent No-go trials (i.e., female voices). Event-related analysis revealed that frontal and temporal areas, including the auditory cortex, were activated during successful and unsuccessful inhibition of predominant responses. Reaction-time (RT) variability throughout the auditory gradCPT was positively correlated with signal changes in regions of the dorsal attention network: superior frontal gyrus and superior parietal lobule. Energy landscape analysis showed that task-related activations could be clustered into different attractors: regions of the dorsal attention network and default mode network. The number of alternations between RT-stable and erratic periods increased with an increase in transitions between attractors in the brain. Therefore, we conclude that dynamic transitions between brain states are closely linked to auditory attentional fluctuations.

Modelling state-transition dynamics in resting-state brain signals by the hidden Markov and Gaussian mixture models

Recent studies have proposed that one can summarize brain activity into dynamics among a relatively small number of hidden states and that such an approach is a promising tool for revealing brain function. Hidden Markov models (HMMs) are a prevalent approach to inferring such neural dynamics among discrete brain states. However, the impact of assuming Markovian structure in neural time series data has not been sufficiently examined. Here, to address this situation and examine the performance of the HMM, we compare the model with the Gaussian mixture model (GMM), which is with no temporal regularization and thus a statistically simpler model than the HMM, by applying both models to synthetic time series generated from empirical resting‐state functional magnetic resonance imaging (fMRI) data. We compared the GMM and HMM for various sampling frequencies, lengths of recording per participant, numbers of participants and numbers of independent component signals. We find that the HMM attains a better accuracy of estimating the hidden state than the GMM in a majority of cases. However, we also find that the accuracy of the GMM is comparable to that of the HMM under the condition that the sampling frequency is reasonably low (e.g., TR = 2.88 or 3.60 s) or the data are relatively short. These results suggest that the GMM can be a viable alternative to the HMM for investigating hidden‐state dynamics under this condition.

Presynaptic inhibition of dopamine neurons controls optimistic bias

Regulation of reward signaling in the brain is critical for appropriate judgement of the environment and self. In Drosophila, the protocerebral anterior medial (PAM) cluster dopamine neurons mediate reward signals. Here, we show that localized inhibitory input to the presynaptic terminals of the PAM neurons titrates olfactory reward memory and controls memory specificity. The inhibitory regulation was mediated by metabotropic gamma-aminobutyric acid (GABA) receptors clustered in presynaptic microdomain of the PAM boutons. Cell type-specific silencing the GABA receptors enhanced memory by augmenting internal reward signals. Strikingly, the disruption of GABA signaling reduced memory specificity to the rewarded odor by changing local odor representations in the presynaptic terminals of the PAM neurons. The inhibitory microcircuit of the dopamine neurons is thus crucial for both reward values and memory specificity. Maladaptive presynaptic regulation causes optimistic cognitive bias.

Closer to critical resting-state neural dynamics in individuals with higher fluid intelligence

According to the critical brain hypothesis, the brain is considered to operate near criticality and realize efficient neural computations. Despite the prior theoretical and empirical evidence in favor of the hypothesis, no direct link has been provided between human cognitive performance and the neural criticality. Here we provide such a key link by analyzing resting-state dynamics of functional magnetic resonance imaging (fMRI) networks at a whole-brain level. We develop a data-driven analysis method, inspired from statistical physics theory of spin systems, to map out the whole-brain neural dynamics onto a phase diagram. Using this tool, we show evidence that neural dynamics of human participants with higher fluid intelligence quotient scores are closer to a critical state, i.e., the boundary between the paramagnetic phase and the spin-glass (SG) phase. The present results are consistent with the notion of "edge-of-chaos" neural computation.

Bridging the Micro-Macro Gap between Single-Molecular Behavior and Bulk Hydrolysis Properties of Cellulase

The microscopic kinetics of enzymes at the single-molecule level often deviate considerably from those expected from bulk biochemical experiments. Here, we propose a coarse-grained-model approach to bridge this gap, focusing on the unexpectedly slow bulk hydrolysis of crystalline cellulose by cellulase, which constitutes a major obstacle to mass production of biofuels and biochemicals. Building on our previous success in tracking the movements of single molecules of cellulase on crystalline cellulose, we develop a mathematical description of the collective motion and function of enzyme molecules hydrolyzing the surface of cellulose. Model simulations robustly explained the experimental findings at both the microscopic and macroscopic levels and revealed a hitherto-unknown mechanism causing a considerable slowdown of the reaction, which we call the crowding-out effect. The size of the cellulase molecule impacted significantly on the collective dynamics, whereas the rate of molecular motion on the surface did not.

A case of adenoid cystic carcinoma of the breast

An 85-year old woman who had a large tumor in the left breast came to our out-patient clinic. Computed tomography showed multiple lung tumors in addition to a huge tumor in the left breast. A needle biopsy brought about a histological diagnosis of ductal carcinoma. A simple mastectomy was performed and a histological examination using the resected specimen demonstrated a coexistence of an adenoid structure and a false ductal structure according the histologic characteristics of adenoid cystic carcinoma, which is quite rare among breast tumors. J. Med. Invest. 65:289-291, August, 2018.

Further evidence to demonstrate the significance of serum appearance of anti-p53 antibody as a marker for progressive potential in invasive ductal carcinoma of the breast

BACKGROUND

Serum appearance of anti-p53 antibody (p53Ab) has been reported as an indicator for progressive potential of human tumor tumors including breast cancer. But its significance in breast cancer has not been discussed fully.

METHODS

Relationship between serum appearance of p53Abs and representative data accounting for progressive potential in breast cancer, nuclear grade (NG), triple negative cancer, and the cumulative score based on these two data (TGS) was investigated among 129 women with invasive ductal carcinoma (IDC) of the breast, who had been treated with surgical resection.

RESULTS

There was a significant correlation between appearance of p53Abs and recurrence of the tumors (P = 0.035). Significant correlation of serum appearance of p53Abs with negative expression of ER (P = 0.011), the proportion of TNBC (P = 0.013), NG (P = 0.017), and TGS (P = 0.0005).

CONCLUSIONS

Preoperative serum appearance of p53Abs can be correlated with pathological nuclear grade, incidence of triple negative breast cancer, and TGS. These results might demonstrate more powerful significance of serum appearance of p53Abs as an indicator of progressive potential in IDC of the breast. J. Med. Invest. 64: 241-244, August, 2017.

Age-related changes in the ease of dynamical transitions in human brain activity

Executive functions, a set of cognitive processes that enable flexible behavioral control, are known to decay with aging. Because such complex mental functions are considered to rely on the dynamic coordination of functionally different neural systems, the age-related decline in executive functions should be underpinned by alteration of large-scale neural dynamics. However, the effects of age on brain dynamics have not been firmly formulated. Here, we investigate such age-related changes in brain dynamics by applying "energy landscape analysis" to publicly available functional magnetic resonance imaging data from healthy younger and older human adults. We quantified the ease of dynamical transitions between different major patterns of brain activity, and estimated it for the default mode network (DMN) and the cingulo-opercular network (CON) separately. We found that the two age groups shared qualitatively the same trajectories of brain dynamics in both the DMN and CON. However, in both of networks, the ease of transitions was significantly smaller in the older than the younger group. Moreover, the ease of transitions was associated with the performance in executive function tasks in a doubly dissociated manner: for the younger adults, the ability of executive functions was mainly correlated with the ease of transitions in the CON, whereas that for the older adults was specifically associated with the ease of transitions in the DMN. These results provide direct biological evidence for age-related changes in macroscopic brain dynamics and suggest that such neural dynamics play key roles when individuals carry out cognitively demanding tasks.

Clustering Coefficients for Correlation Networks

Graph theory is a useful tool for deciphering structural and functional networks of the brain on various spatial and temporal scales. The clustering coefficient quantifies the abundance of connected triangles in a network and is a major descriptive statistics of networks. For example, it finds an application in the assessment of small-worldness of brain networks, which is affected by attentional and cognitive conditions, age, psychiatric disorders and so forth. However, it remains unclear how the clustering coefficient should be measured in a correlation-based network, which is among major representations of brain networks. In the present article, we propose clustering coefficients tailored to correlation matrices. The key idea is to use three-way partial correlation or partial mutual information to measure the strength of the association between the two neighboring nodes of a focal node relative to the amount of pseudo-correlation expected from indirect paths between the nodes. Our method avoids the difficulties of previous applications of clustering coefficient (and other) measures in defining correlational networks, i.e., thresholding on the correlation value, discarding of negative correlation values, the pseudo-correlation problem and full partial correlation matrices whose estimation is computationally difficult. For proof of concept, we apply the proposed clustering coefficient measures to functional magnetic resonance imaging data obtained from healthy participants of various ages and compare them with conventional clustering coefficients. We show that the clustering coefficients decline with the age. The proposed clustering coefficients are more strongly correlated with age than the conventional ones are. We also show that the local variants of the proposed clustering coefficients (i.e., abundance of triangles around a focal node) are useful in characterizing individual nodes. In contrast, the conventional local clustering coefficients were strongly correlated with and therefore may be confounded by the node's connectivity. The proposed methods are expected to help us to understand clustering and lack thereof in correlational brain networks, such as those derived from functional time series and across-participant correlation in neuroanatomical properties.

Energy landscape analysis of neuroimaging data

Computational neuroscience models have been used for understanding neural dynamics in the brain and how they may be altered when physiological or other conditions change. We review and develop a data-driven approach to neuroimaging data called the energy landscape analysis. The methods are rooted in statistical physics theory, in particular the Ising model, also known as the (pairwise) maximum entropy model and Boltzmann machine. The methods have been applied to fitting electrophysiological data in neuroscience for a decade, but their use in neuroimaging data is still in its infancy. We first review the methods and discuss some algorithms and technical aspects. Then, we apply the methods to functional magnetic resonance imaging data recorded from healthy individuals to inspect the relationship between the accuracy of fitting, the size of the brain system to be analysed and the data length.This article is part of the themed issue 'Mathematical methods in medicine: neuroscience, cardiology and pathology'.

Pharmacokinetics, efficacy and safety of daclatasvir plus asunaprevir in dialysis patients with chronic hepatitis C: pilot study

The aim of this study was to evaluate the pharmacokinetic profile of daclatasvir (DCV) and asunaprevir (ASV) dual therapy in haemodialysis patients infected with hepatitis C virus (HCV). Eighteen haemodialysis patients and 54 patients with normal renal function were treated with DCV and ASV dual therapy for 24 weeks. We evaluated the pharmacokinetic profiles of DCV and ASV and examined the rate of sustained virological response 12 weeks after the end of treatment (SVR₁₂ ) and incidence of adverse events during treatment of haemodialysis patients infected with chronic HCV genotype 1 infection. To adjust for potential differences in baseline characteristics between haemodialysis patients and patients with normal renal function, we used propensity scores case-control matching methods. Area under the plasma concentration time curve from 0 to 6 h (AUC_{0-6 h} ) of DCV was slightly lower in haemodialysis patients than in patients with normal renal function (P > 0.6). AUC_{0-6 h} of ASV was significantly lower in haemodialysis patients (P = 0.012). SVR₁₂ rates were 100% (18/18) for haemodialysis and 96.2% (52/54) for patients with normal renal function. Changes in mean log₁₀ HCV RNA levels and viral response were higher in haemodialysis patients compared to patients with normal renal function. No discontinuations due to adverse events occurred. In conclusion, DCV and ASV dual therapy for HCV infection is effective and safe with similar results in haemodialysis patients compared to patients with normal renal function.

Jamming transitions in force-based models for pedestrian dynamics

Force-based models describe pedestrian dynamics in analogy to classical mechanics by a system of second order ordinary differential equations. By investigating the linear stability of two main classes of forces, parameter regions with unstable homogeneous states are identified. In this unstable regime it is then checked whether phase transitions or stop-and-go waves occur. Results based on numerical simulations show, however, that the investigated models lead to unrealistic behavior in the form of backwards moving pedestrians and overlapping. This is one reason why stop-and-go waves have not been observed in these models. The unrealistic behavior is not related to the numerical treatment of the dynamic equations but rather indicates an intrinsic problem of this model class. Identifying the underlying generic problems gives indications how to define models that do not show such unrealistic behavior. As an example we introduce a force-based model which produces realistic jam dynamics without the appearance of unrealistic negative speeds for empirical desired walking speeds.

Rerupture of nonparasitic liver cyst treated with cyst fenestration: a case report

We herein describe a case involving spontaneous rerupture of a nonparasitic liver cyst successfully treated with cyst fenestration and an omental flap. A 59-year-old Japanese woman was transferred to our hospital for evaluation of acute abdominal pain. She had a history of conservative treatment with antibiotics for spontaneous rupture of a liver cyst 1 month previously. On arrival, she exhibited abdominal tenderness and muscular defense. Enhanced computed tomography showed ascites and a large ruptured hepatic cyst (diameter of 10 cm). We diagnosed rerupture of a liver cyst and performed laparotomy for cyst fenestration and intraperitoneal drainage. During the operation, we found the perforation site on the ventral side of the cyst and brown, muddled ascitic fluid. Cholangiography showed no bile leakage on the inner wall. Pathological investigation revealed no evidence of malignancy. The patient recovered without any adverse events and was discharged on postoperative day 8. No recurrences or complications occurred for 2 years.

Potential global jamming transition in aviation networks

In this paper, we propose a nonlinear transport model for an aviation network. The takeoff rate from an airport is characterized by the degree of ground congestion. Due to the effect of surface congestion, the performance of an airport deteriorates because of inefficient configurations of waiting aircraft on the ground. Using a simple transport model, we performed simulations on a United States airport network and found a global jamming transition induced by local surface congestion. From a physical perspective, the mechanism of the transition is studied analytically and the resulting aircraft distribution is discussed considering system dynamics. This study shows that the knowledge of the relationship between a takeoff rate and a congestion level on the ground is vital for efficient air traffic operations.

Prognostic criteria in colorectal carcinoma constructed by the combination of tumor-related and host-related factors

BACKGROUND

The significance of prognostic criteria based on a combination of tumor-related and host-related factors for patients with colorectal carcinoma has not been appreciated fully.

METHODS

Correlation of tumor-related and host-related score (TRHRS), which are constructed by the combination of serum elevation of C-reactive protein and pathologic lymph node metastasis (scores ranging 0 to 2), with clinicopathologic features including prognosis was studied in 271 patients with colorectal carcinoma who had been treated with curative resection.

RESULTS

Significant difference regarding survival was observed both between TRHRS 0 and 1 (P = .028) and between TRHRS 1 and 2 (P < .0001). Multivariate analysis showed that histologic types (P = .040) and TRHRS (P < .0001) were independent prognostic indicators.

CONCLUSION

Criteria for the prediction of prognosis in colorectal carcinoma treated with curative resection based on both tumor-related and host-related factors could provide a strict stratification.

Impact of high preoperative steroid doses on postoperative complications among patients on prolonged preoperative steroid therapy

Corticosteroids are essential to maintain the organic homeostasis. Steroid, glucocorticoid or its synthetic analog is widely used for inflammatory and autoimmune diseases. Prolonged steroid therapy is reported to cause the susceptibility to infection, impaired wound healing and psychoneurosis, however whether the quantity of taking the preoperative steroid is associated the postoperative complication is still unknown. The aim of this study was to elucidate whether the steroid dose in patients on prolonged preoperative steroid therapy is associated postoperative morbidity and mortality. Twenty-five patients taking steroid for various illnesses and underwent the surgery under general anesthesia were selected in this study. The mean +/- standard deviation and the median of the steroid dose converted into hydrocortisone (mg/day) were 39.2 +/- 31.0 and 20, respectively. Of 25 cases, postoperative complications were seen in 10 cases. The postoperative complication was severe based on the grade of Clavien and Dindo by ANOVA as the doses of taking steroid increased (p = 0.0171). The grave postoperative complication classified as Clavien and Dindo grade III occurred with 100% sensitivity and 87% specificity for the steroid dose converted into hydrocortisone > 80 mg/day. Preoperative taking the large amount of steroid (> 80 mg/day) could cause a grave complication. More careful selection of the operative procedure might improve the mobidity rate.

New criteria to predict tumor recurrence in invasive ductal carcinoma of the breast

Incidence of triple-negative breast cancer (TNBC), which is cancer without expression of ER, PgR, and HER2, and nuclear grade (NG) are closely correlated with malignant potential of breast cancer. However, criteria to determine aggressiveness of breast cancer based on these factors have not been elucidated. The aim of this study was to create criteria using these factors to predict tumor recurrence in invasive ductal carcinoma (IDC) of the breast. One hundred and seventy-nine patients with IDC of the breast, which had been treated by surgical resection, were included. One point was added for each factor of the two categories of TNBC and NG 3. The sum of the scores (TGS 0, 1, or 2) was calculated. Significant difference was observed between TGS and the incidence of tumor recurrence (P < 0.0001). Moreover, significant differences were observed regarding relapse-free survival (RFS) between patients with TGS 0 and TGS 1 (P < 0.0001) and patients with TGS 1 and TGS 2 (P = 0.024). TGS might contain a clinical advantage as a useful predictor for tumor recurrence of IDC of the breast and could classify prognosis of the patients with a preferable stratification.

Collective motion of oscillatory walkers

We study a system of interacting self-propelled particles whose walking velocity depends on the stage of the locomotion cycle. The model introduces a phase equation in the optimal velocity model for vehicular traffic. We find that the system exhibits novel types of flow: synchronized free flow, phase-anchoring free flow, orderly jam flow, and disordered jam flow. The first two flows are characterized by synchronization of the phase, while the others do not have the global synchronization. Among these, the disordered jam flow is very complex, although the underlying model is simple. This phenomenon implies that the crowd behavior of moving particles can be destabilized by coupling their velocity to the phase of their motion. We also focus on "phase-anchoring" phenomena. They strongly affect particle flow in the system, especially when the density of particles is high.

[Combined therapy of lapatinib and capecitabine effective against local recurrence of breast cancer]

A 67-year-old woman after mastectomy was afflicted with local recurrence of left breast cancer during adjuvant trastuzumab therapy. Oral administration of lapatinib and capecitabine served to distinguish the recurrent tumor and also reduce the patient's distressing symptoms. This combined anti-cancer therapy may be available for patients with breast cancer for whom trastuzumab therapy was not adequately effective.

Quality of gastric cancer care in designated cancer care hospitals in Japan

OBJECTIVE

To develop a set of process-of-care quality indicators (QIs) that would cover a wide range of gastric cancer care modalities and to examine the current state of the quality of care provided by designated cancer care hospitals in Japan.

DESIGN

A retrospective medical record review.

SETTING

Eighteen designated cancer care hospitals throughout Japan.

PARTICIPANTS

A total of 1685 patients diagnosed with gastric cancer in 2007.

MAIN OUTCOME MEASURES

Provision of care to eligible patients as described in the 29 QIs, which were developed using an adaptation of the RAND/UCLA (University of California, Los Angeles) appropriateness method by a panel of nationally recognized experts in Japan.

RESULTS

Overall, the patients received 68.3% of the care processes recommended by the QIs. While 'deep venous thrombosis prophylaxis before major surgery' was performed for 99% of the cases, 'documentation before endoscopic resection' was completed for only 12% of the cases. The chemotherapy care was less likely to meet the QI standards (61%) than pre-therapeutic care (76%), surgical treatment (66%) and endoscopic resection (71%; overall difference: P < 0.001). A comparison based on the types of care showed that documentation and patient explanation were performed less frequently (60 and 53%, respectively) than were diagnostic and therapeutic processes as recommended in the QIs (85%; overall P < 0.001).

CONCLUSIONS

Although many required care processes were provided, some areas with room for improvement were revealed, especially with respect to chemotherapy, documentation and patient explanation. Continuous efforts to improve the quality and develop a system to monitor this progress would be beneficial in Japan.

Five-point scoring system based on clinicopathological data: A convenient criterion to determine prognosis of patients with colorectal carcinoma

The aim of this study was to elucidate the significance of a novel staging criterion, a five-point scoring system (FPSS), determined by five histopathological factors of colorectal carcinoma. These factors included depth of invasion, lymph node metastasis, lymphatic invasion, venous invasion and histopathological tumor type. In total, 357 patients with colorectal carcinoma who had had been treated by surgical resection were investigated. One point was assigned to each of the five aforementioned tumor-related pathological factors. The FPSS score was determined by an aggregate of the points. A significant difference was observed between the survival of patients with FPSS scores of 0 and 1, and 2 and 3 (P=0.0002); and FPSS scores of 2 and 3, and 4 and 5 (P<0.0001). We demonstrate that the FPSS is a convenient criterion for stratifying the prognosis of patients with colorectal carcinoma.

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.