Impact of Multiplex Polymerase Chain Reaction Test in Patients With Meningitis or Encephalitis

Background

The objective of this study was to evaluate the impact of the FilmArray meningitis/encephalitis panel (FAME) on length of stay (LOS) and duration of antimicrobial treatment in children and adults in a Japanese community hospital.

Methods

This retrospective cohort study was conducted in Japan between January 2016 and December 2022. We included hospitalized patients with cerebrospinal fluid (CSF) samples and those aged <2 months or who had 5 or more white blood cells/μL in the CSF. To compare the days of therapy (DOT) and LOS between the pre-FAME and FAME periods, multivariate Poisson regression analyses were conducted without an offset term.

Results

The number of cases undergoing pathogen-specific polymerase chain reaction increased from 3.7% in the pre-FAME period to 57.5% in the FAME period (P < .001). The pathogen identification rate also increased during the FAME period, from 0.4% to 18.7% (P < .001). While the antibacterial DOT was not statistically different between the 2 periods (adjusted rate ratio [aRR], 1.06 [95% confidence interval {CI}, 1.00-1.13]; P = .063]), the antiviral DOT was significantly shorter in the FAME period (aRR, 0.80 [95% CI, .71-.89]; P < .001).

Conclusions

This study revealed a significant reduction in antiviral use during the FAME period, whereas LOS and antibacterial use did not decrease. Given the possibility of factors (eg, the COVID-19 pandemic) affecting the epidemiology of meningitis and encephalitis, the indications and impact of the FAME test should be evaluated with continuous monitoring of the epidemiology of meningitis and encephalitis and its clinical impact.

Pasteurella bettyae infection requiring finger amputation due to rapid deterioration and tissue damage

We report a case of infection of the middle finger of a 69-year-old man who visited our hospital. Pus was collected from the erythematous and swollen area of the nail cage of the left-hand middle finger and evaluated in our microbiology laboratory. Gram staining of the specimen revealed multinucleated leukocytes and abundant gram-negative bacilli. Isolated colonies were identified as Pasteurella bettyae using VITEK MS and 16 S ribosomal RNA (rRNA) gene sequencing. The patient's blood test results improved after treatment with penicillin, but the local factors affecting the finger did not improve, and amputation of the middle finger had to be performed. This case represents a report of a very rare hand infection caused by P. bettyae. Polymorphic identification methods, such as MALDI-TOF MS and 16 S rRNA gene sequencing, are needed for members of the genus Pasteurella isolated from severe infections and abnormal sites, and further studies are warranted.

Impact of the COVID-19 pandemic and multiplex polymerase chain reaction test on outpatient antibiotic prescriptions for pediatric respiratory infection

This study aimed to evaluate the impact of the prolonged COVID-19 pandemic on outpatient antibiotic prescriptions for pediatric respiratory infections at an acute care hospital in Japan in order to direct future pediatric outpatient antibiotic stewardship. The impact of the COVID-19 pandemic and the FilmArray Respiratory Panel (RP) on outpatient antibiotic prescriptions was assessed from January 2019 to December 2021 using an interrupted time series analysis of children <20 years. The overall antimicrobial prescription rate decreased from 38.7% to 22.4% from the pre-pandemic period to the pandemic. The pandemic (relative risk [RR] level, 0.97 [0.58-1.61]; P = 0.90; RR slope, 1.05 [0.95-1.17] per month; P = 0.310) and FilmArray RP (RR level, 0.90 [0.46-1.75]; P = 0.75; RR slope, 0.95 [0.85-1.06] per month; P = 0.330) had no significant effect on the monthly antibiotic prescription rates. The COVID-19 pandemic was not significantly related to the antibiotic prescription rate, suggesting that it did not impact physicians' behavior toward antibiotic prescriptions. Replacing rapid antigen tests with the FilmArray RP introduced on December 1, 2020, did not affect the magnitude of the reduction in antibiotic prescription rate for pediatric respiratory infections.

Tocilizumab and Baricitinib for Recovery From Acute Exacerbation of Combined Pulmonary Fibrosis and Emphysema Secondary to COVID-19 Infection: A Case Report

Pneumonia secondary to coronavirus disease 2019 (COVID-19) is exacerbated by a disproportionate increase in the systemic inflammatory response and cytokine storm due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Herein, we report the successful treatment of severe COVID-19 pneumonia using a combination of tocilizumab and baricitinib in a patient with combined pulmonary fibrosis and emphysema (CPFE). A 67-year-old male with type 2 diabetes mellitus and CPFE presented with fever and dyspnea and was diagnosed with COVID-19. Upon admission, his respiratory failure was managed using high-flow nasal cannula (HFNC) therapy; however, despite treatment with remdesivir and systemic steroids, his respiratory failure continued to worsen. Therefore, baricitinib was administered from the ninth day of hospitalization for 14 days. Furthermore, his blood interleukin-6 (IL-6) levels showed an increase until day 13. Thus, tocilizumab was administered on the 13th day, which led to symptomatic improvement by day 18. The patient was discharged from our hospital on day 42. This case indicates that combination therapy with tocilizumab and baricitinib improves the efficacy of COVID-19 treatment in patients with comorbidities.

Improvement of peripheral neuropathy in a patient with antineutrophil cytoplasmic antibody-negative eosinophilic granulomatosis with polyangiitis by additional mepolizumab

Background

Eosinophilic granulomatosis with polyangiitis (EGPA) is a vasculitis characterized by abnormally high eosinophils and frequent peripheral neuropathy. Mepolizumab is an approved therapy for EGPA, but its efficacy against peripheral neuropathy remains unknown.

Case presentation

A 41-year-old woman was admitted in the hospital with dyspnea and neuropathy. Ground glass opacity and infiltrative shadow in the bilateral lungs were evident on chest computed tomography images. Eosinophils were increased in serum, in bronchoalveolar lavage fluid (BALF), and in transbronchial lung biopsy, and bacteria were not detected in BALF. EGPA resulting in severe eosinophilic asthma, sinusitis, pulmonary infiltrates, and peripheral neuropathy was diagnosed. Prednisolone (50 mg/day) caused remission of eosinophilic pneumonia and sinusitis, but not peripheral neuropathy. During prednisolone tapering (7 mg/day, 10 months after treatment), eosinophils were increased, and peripheral neuropathy relapsed. The humanized anti-IL-5 antibody mepolizumab (300 mg) was initially administered, followed by prednisolone. Mepolizumab caused sustained peripheral neuropathy remission and effective prednisolone tapering.

Conclusions

Introduction of mepolizumab combined with prednisolone may improve peripheral neuropathy.

Radiation therapy for primary vaginal carcinoma

Brachytherapy plays a significant role in the management of cervical cancer, but the clinical significance of brachytherapy in the management of vaginal cancer remains to be defined. Thus, a single institutional experience in the treatment of primary invasive vaginal carcinoma was reviewed to define the role of brachytherapy. We retrospectively reviewed the charts of 36 patients with primary vaginal carcinoma who received definitive radiotherapy between 1992 and 2010. The treatment modalities included high-dose-rate intracavitary brachytherapy alone (HDR-ICBT; two patients), external beam radiation therapy alone (EBRT; 14 patients), a combination of EBRT and HDR-ICBT (10 patients), or high-dose-rate interstitial brachytherapy (HDR-ISBT; 10 patients). The median follow-up was 35.2 months. The 2-year local control rate (LCR), disease-free survival (DFS), and overall survival (OS) were 68.8%, 55.3% and 73.9%, respectively. The 2-year LCR for Stage I, II, III and IV was 100%, 87.5%, 51.5% and 0%, respectively (P = 0.007). In subgroup analysis consisting only of T2-T3 disease, the use of HDR-ISBT showed marginal significance for favorable 5-year LCR (88.9% vs 46.9%, P = 0.064). One patient each developed Grade 2 proctitis, Grade 2 cystitis, and a vaginal ulcer. We conclude that brachytherapy can play a central role in radiation therapy for primary vaginal cancer. Combining EBRT and HDR-ISBT for T2-T3 disease resulted in good local control.

Phase III randomised controlled trial of neoadjuvant chemotherapy plus radical surgery vs radical surgery alone for stages IB2, IIA2, and IIB cervical cancer: a Japan Clinical Oncology Group trial (JCOG 0102)

Background:

A phase III trial was conducted to determine whether neoadjuvant chemotherapy (NACT) before radical surgery (RS) improves overall survival.

Methods:

Patients with stage IB2, IIA2, or IIB squamous cell carcinoma of the uterine cervix were randomly assigned to receive either BOMP (bleomycin 7 mg days 1–5, vincristine 0.7 mg m⁻² day 5, mitomycin 7 mg m⁻² day 5, cisplatin 14 mg m⁻² days 1–5, every 3 weeks for 2 to 4 cycles) plus RS (NACT group) or RS alone (RS group). Patients with pathological high-risk factors received postoperative radiotherapy (RT). The primary end point was overall survival.

Results:

A total of 134 patients were randomly assigned to treatment. This study was prematurely terminated at the first planned interim analysis because overall survival in the NACT group was inferior to that in the RS group. Patients who received postoperative RT were significantly lower in the NACT group (58%) than in the RS group (80% P=0.015). The 5-year overall survival was 70.0% in the NACT group and 74.4% in the RS group (P=0.85).

Conclusion:

Neoadjuvant chemotherapy with BOMP regimen before RS did not improve overall survival, but reduced the number of patients who received postoperative RT.

Interleukin-10 gene polymorphism reflects the severity of chronic immune thrombocytopenia in Japanese patients

INTRODUCTION

T-helper cell type 1 (Th1) polarization of the immune response has been documented in patients with chronic immune thrombocytopenia (ITP). Interleukin (IL)-10 is the most important factor regulating Th1 and T-helper type 2 cytokine synthesis. This study evaluated the impact of IL-10 polymorphisms on both susceptibility to, and severity of, chronic ITP.

METHODS

We analyzed -1082(G/A), -812(C/T), and -592(C/A) IL-10 polymorphisms in 90 patients with adult chronic ITP and 202 race- and sex-matched healthy controls.

RESULTS

No significant differences in the genotype or haplotype frequencies were observed between the patient with chronic ITP and the control group. However, more patients with the -592AA genotype showed a severe thrombocytopenic state (platelet count <10 x 10⁹/l) than those with the -592CC/CA genotypes (44.1%vs. 19.6%, P = 0.01). Furthermore, more patients with the ATA/ATA haplotype showed a severe thrombocytopenic state than those without the ATA/ATA haplotype (44.1%vs. 19.6%, P = 0.01).

CONCLUSION

According to our data, patients with low producer type of IL-10 polymorphisms have more severe thrombocytopenia, suggesting that IL-10 gene polymorphisms may reflect the severity of ITP.

Safety and efficacy of a splenectomy during debulking surgery for Müllerian carcinoma

PURPOSE

This study was designed to assess the safety and efficacy of a splenectomy and to analyze the prognostic factors of Müllerian carcinoma with spleen metastasis.

METHODS

We reviewed the medical records of 11 patients with Müllerian carcinoma who underwent a splenectomy between 1997 and 2007. The treatment outcome of these patients was examined and the possible prognostic factors were investigated by univariate analysis.

RESULTS

Four and seven patients underwent a splenectomy for primary and recurrent disease, respectively. A complete resection was achieved in eight patients. A blood transfusion was not required and only two mild postoperative complications were observed. The median and five-year survivals of all patients following treatment were 39 months and 39%, respectively. Older patients (> or = 60 years old) and patients with a poor performance status (PS2) had a poorer prognosis by univariate analysis.

CONCLUSIONS

A splenectomy can be performed safely and effectively during debulking surgery for appropriately selected patients with primary or recurrent Müllerian carcinoma.

Vitamin D deficiency in patients with active systemic lupus erythematosus

We investigated the effects of disease activity on bone metabolism in 36 patients with systemic lupus erythematosus (SLE). Changes in bone remodeling were not explained by corticosteroid use. A high prevalence of 25OHD deficiency in SLE patients indicates the need for vitamin D replacement, mainly during high disease activity periods.

INTRODUCTION

We investigated the effects of SLE disease activity on bone metabolism, their relation to inflammatory cytokines and vitamin D levels.

METHODS

We performed a cross-sectional analysis of 36 SLE patients classified according to the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) in high activity (group I: 12 patients, mean age 29.6 years) or in minimal activity (group II: 24 patients, mean age 30.0 years), and compared them to normal controls (group III: 26 women, 32.8 years). Serum calcium, phosphorus, parathyroid and sex hormones, bone remodeling markers, interleukin (IL)-6, soluble IL-6 receptor (sIL-6R), IL-1, tumor necrosis factor-alpha (TNF), 25-hydroxivitamin D (25OHD), and 1,25-dihydroxyvitamin D3 were measured, plus bone mineral density.

RESULTS

All cytokines were significantly higher in SLE groups; IL-6 could differentiate SLE patients from controls. In group I, 25OHD levels were lower (P < 0.05), which was related to the SLEDAI (R = -0.65, P < 0.001). In multiple regression analysis, the 25OHD level was associated with SLEDAI, osteocalcin and bone-specific alkaline phosphatase. The SLEDAI score was positively correlated with all measured cytokines and especially TNF (R = 0.75, P < 0.001).

CONCLUSIONS

SLE patients demonstrated changes in bone remodeling strongly related to disease activity. A high prevalence of 25OHD deficiency was observed in SLE patients, indicating the need for vitamin D replacement.

Surgical treatment for neuroendocrine carcinoma of the uterine cervix

OBJECTIVE

To identify the best operative approach for neuroendocrine cervical carcinoma (NECC).

METHODS

The records of surgically treated patients with stages IB to IIB NECC were reviewed.

RESULTS

Of 10 patients who met the study criteria for NECC and underwent radical hysterectomy, 4 had pT1bN0, 4 had pT1bN1, 1 had pT2aN0, and 1 had pT2bN1 disease. Those with pT1bN1 or pT2bN1 disease received postoperative adjuvant radiotherapy and/or chemotherapy, and recurrence occurred in 7 patients (70%). Among these 7 patients, 5 (71%) had a primary NECC tumor with deep stromal invasion and 5 (71%) had extrauterine disease (parametrium and/or lymph node). The recurrences in 6 patients (86%) were located outside the pelvis (lung, liver, or brain). Stromal invasion was 6 mm or less in the 3 patients who did not experience disease recurrence.

CONCLUSIONS

Pelvic control by radical hysterectomy may not be beneficial for patients with NECC except for those with an early invasive lesion.

Neural plasticity maintained high by activation of cyclic AMP-dependent protein kinase: an age-independent, general mechanism in cat striate cortex

Adult cats lack ocular dominance plasticity, showing little change in the ocular dominance distribution following monocular deprivation. Ocular dominance plasticity is also lost in kitten visual cortex that has been continuously infused with either catecholaminergic neurotoxin, beta-adrenoreceptor blocker, or inhibitor of cyclic AMP-dependent protein kinase (protein kinase A). Complementarily, in adult cats we showed earlier that pharmacological activation of protein kinase A, albeit partially, restored ocular dominance plasticity. In the present study, we first asked whether, mediated by protein kinase A activation, the same molecular mechanisms could restore ocular dominance plasticity to kitten cortex that once lost the expression of plasticity due to prior pharmacological treatments. Concurrently with monocular deprivation, two kinds of cyclic AMP-related drugs (cholera toxin A-subunit or dibutyryl cyclic AMP) were directly infused in two types of aplastic kitten cortex pretreated with either 6-hydroxydopamine or propranolol. The combined treatment resulted in clear ocular dominance shift to the non-deprived eye, indicating that cortical plasticity was fully restored to aplastic kitten cortex. Next, to directly prove the sensitivity difference in protein kinase A activation between the immature and mature cortex, we compared the thus-obtained data in kittens with the published data derived from adult cats under the comparable experimental paradigm. The extent of ocular dominance changes following monocular deprivation was compared at different drug concentrations in the two preparations: the shifted ocular dominance distribution in aplastic kitten cortex infused with dibutyryl cyclic AMP at the lowest concentration tested and the W-shaped distribution in similarly treated adult cortex at a thousandfold-higher drug concentration that induced nearly maximal changes. We conclude that, irrespective of the animal's age, activation of protein kinase A cascades is a general mechanism to maintain ocular dominance plasticity high, their sensitivity being substantially higher in the immature than mature cortex.

Radical hysterectomy for stage IIB cervical cancer: a review

Patients with stage IIB cervical cancer in some countries in Europe and Asia especially in Japan are usually treated with radical hysterectomy and pelvic lymphadenectomy. Extrauterine diseases, ie, nodal metastases, parametrial invasion, and intraperitoneal spread, can be readily identified. We present the literature review of radical hysterectomy in stage IIB cervical cancer by searching data since 1980 from Medline, and we found that the parametrial involvement of patients in this stage was only 21-55%, the incidence of pelvic node metastases was about 35-45%, and 5-year survival rate was between 55% and 77%. Lymph node metastases and the number of positive nodes were significant prognostic factors of patients in this stage.

Genotoxicity studies on dietary diacylglycerol (DAG) oil

Dietary diacylglycerol (DAG) oil is an edible oil enriched in DAG (more than 80%). A recent investigation indicated that DAG oil or its components may have beneficial effects on the prevention and management of obesity. We evaluated the genotoxic potential of DAG oil using standard genotoxicity tests. Bacterial reverse mutation assay (Ames test), the chromosomal aberration assay in cultured Chinese hamster lung cells (CHL/IU), and a bone marrow micronucleus assay in ICR CD mice were employed in the present study. In addition we have tested the possibility that genotoxic substances may be formed during cooking, heated DAG oil (HDG) was prepared by batch frying potato slices in the oil at 180 degrees C for 8 h/day for three consecutive days. Therefore, genotoxicity tests were also performed on HDG. Results obtained did not show any genotoxic effect on either unheated DAG oil (UDG) or HDG. We conclude that there are no safety concerns on the genotoxicity of DAG oil under the conditions for normal use.

Clinical aspects and prognosis of pelvic recurrence of cervical carcinoma

OBJECTIVE

To identify which patients with locally recurrent cervical carcinoma are potentially curable.

METHOD

A total of 664 stage IB-IVA patients were examined following surgery or radiotherapy.

RESULT

Among the 664 patients, 193 (29%) developed recurrence. Sixty-seven (35%) of these recurrences were located in the pelvis alone. Among these 67 recurrences, 24 (35%) were central recurrences and the remaining 43 (65%) were pelvic side-wall recurrences. Of the 24 patients with central recurrences, 8 were salvaged. Of these 8 patients, 3 underwent pelvic exenteration, and 5 received optimal radiotherapy. The recurrent tumor in these 5 survivors who received radiotherapy had consisted of a small (<2 cm) tumor. All 43 patients with pelvic wall recurrence developed progressive disease.

CONCLUSION

The following patients are potentially curable: patients with a resectable, centrally located tumor who are candidates for pelvic exenteration, and patients with a small central recurrence for whom complete radiation therapy is feasible.

Prognostic significance of positive peritoneal cytology in endometrial carcinoma confined to the uterus

A retrospective analysis was performed to evaluate the prognostic significance of peritoneal cytology in patients with endometrial carcinoma limited to the uterus. A total of 280 patients with surgically staged endometrial carcinoma that was histologically confined to the uterus were examined clinicopathologically. The median length of follow-up was 62 (range, 12-135) months. All patients underwent hysterectomy and salpingo-oophorectomy with selective lymphadenectomy, and only three patients received adjuvant postoperative therapy. No preoperative adjuvant therapy was employed. In all, 48 patients (17%) had positive peritoneal cytology. The 5-year survival rate among patients with positive or negative peritoneal cytology was 91 or 95%, respectively, showing no significant difference (log-rank, P=0.42). The disease-free survival rate at 36 months was 90% among patients with positive cytology, compared with that of 94% among patients with negative cytology, and the difference was not significant (log-rank, P=0.52). Multivariate proportional hazards model revealed only histologic grade to be an independent prognostic factor of survival (P=0.0003, 95% CI 3.02 - 40.27) among the factors analysed (age, peritoneal cytology, and depth of myometrial invasion). Multivariate analysis revealed that histologic grade (P=0.02, 95% CI 1.21-9.92) was also the only independent prognostic factor of disease-free survival. We concluded that the presence of positive peritoneal cytology is not an independent prognostic factor in patients with endometrial carcinoma confined to the uterus, and adjuvant therapy does not appear to be beneficial in these patients.

Bone loss at the lumbar spine and the proximal femur in a rural Japanese community, 1990-2000: the Miyama study

Bone mineral density (BMD) was measured over a ten year period in a cohort study in Miyama village, Wakayama Prefecture, Japan, to provide information on rate of bone loss in the mature and elderly population. Four hundred subjects were selected by sex and age decade from the full list of residents born in 1910-1949, and aged 40-79 years at the end of 1989, with 50 men and 50 women in each age decade. Baseline BMD of the lumbar spine and the proximal femur was measured using dual energy X-ray absorptiometry (DXA) in 1990 and again in 1993, 1997 and 2000. Annual rate of change in BMD (% per year) in the lumbar spine in men in their forties, fifties, sixties and seventies was 0.17, 0.55, 0.01 and -0.16, respectively, and in women, -0.87, -0.83, -0.48 and -0.48, respectively. Thus in men, BMD at the lumbar spine increased in all age strata but the oldest, when it decreased, whereas in women, it decreased in all age strata. On the other hand, BMD at the proximal femur decreased in both sexes in all age strata. Our results show that bone loss rates differ depending on the site involved, demonstrating that different strategies are needed for the prevention of bone loss in the spine and hip.Furthermore, we found evidence of differences in BMD for given age strata between birth cohorts. Data in 1990 and in 2000 showed significant improvements for men in their sixties and for women in their fifties, suggesting that future problems of osteoporosis might be less severe than has previously been predicted in Japan.

Immature glandular features in squamous cell carcinoma of the uterine cervix as an independent indicator of resistance to radiotherapy

The aim of this study was to evaluate the significance of "immature glandular features" in cervical squamous cell carcinoma (SCC) as an indicator of tumor radioresistance. Pretreatment biopsied tissue specimens of cervical SCC from 100 patients who were uniformly treated with radiotherapy alone were classified into clinically radioresistant (cR) and radiosensitive (cS) groups. Seven histologic parameters comprising glassy cells, signet ring cells, squamous differentiation, recognizable gland, nuclear atypia, stromal response, and mitotic counts were examined. Glassy cells and signet ring cells were regarded as "immature glandular features". The correlation of these seven parameters with tumor response to radiotherapy and patient prognosis was analyzed by univariate and multivariate analyses. As objective indicators of glandular differentiation, alcian-blue staining and immunostaining of cytokeratins 7 and 20 were also performed. It was revealed that immature glandular features, absence of squamous differentiation, and low nuclear atypia were significant indicators of radioresistance of the tumor and of poorer patient prognosis. Combining those histological parameters, the present SCC cases were classified into 26 pathologically radioresistant (pR) and 74 radiosensitive (pS) groups. In the pR group, 54% (14 of 26) were clinically radioresistant, whereas 20% (15 of 74) of the pS group were clinically radioresistant (P = 0.002). The overall prognosis of the pR group was much poorer than that of the pS group (P < 0.0001). This correlation also held true in cases of identical stage and age. We could not show objectively glandular differentiation of "immature glandular features". Nonetheless, the identification of "immature glandular features" was effective in predicting the radiotherapy resistance of cervical SCC and poorer patient prognosis.

Immature glandular features in squamous cell carcinoma of the uterine cervix as an independent indicator of resistance to radiotherapy

Abstract.

Okada S, Tsuda H, Ohmi K, Kasamatsu T, Yamada T, Tsunematsu R, Sumi M, Tokuuye K, Yoshikawa H, Hirohashi S. Immature glandular features in squamous cell carcinoma of the uterine cervix as an independent indicator of resistance to radiotherapy.

The aim of this study was to evaluate the significance of “immature glandular features” in cervical squamous cell carcinoma (SCC) as an indicator of tumor radioresistance. Pretreatment biopsied tissue specimens of cervical SCC from 100 patients who were uniformly treated with radiotherapy alone were classified into clinically radioresistant (cR) and radiosensitive (cS) groups. Seven histologic parameters comprising glassy cells, signet ring cells, squamous differentiation, recognizable gland, nuclear atypia, stromal response, and mitotic counts were examined. Glassy cells and signet ring cells were regarded as “immature glandular features”. The correlation of these seven parameters with tumor response to radiotherapy and patient prognosis was analyzed by univariate and multivariate analyses. As objective indicators of glandular differentiation, alcian-blue staining and immunostaining of cytokeratins 7 and 20 were also performed. It was revealed that immature glandular features, absence of squamous differentiation, and low nuclear atypia were significant indicators of radioresistance of the tumor and of poorer patient prognosis. Combining those histological parameters, the present SCC cases were classified into 26 pathologically radioresistant (pR) and 74 radiosensitive (pS) groups. In the pR group, 54% (14 of 26) were clinically radioresistant, whereas 20% (15 of 74) of the pS group were clinically radioresistant (P = 0.002). The overall prognosis of the pR group was much poorer than that of the pS group (P < 0.0001). This correlation also held true in cases of identical stage and age. We could not show objectively glandular differentiation of “immature glandular features”. Nonetheless, the identification of “immature glandular features” was effective in predicting the radiotherapy resistance of cervical SCC and poorer patient prognosis.

Primary epithelioid sarcoma of the vulva

A case of a 31-year-old woman with epithelioid sarcoma of the vulva which metastasized to the regional lymph node 8 years after onset of the disease is reported here. The patient first noticed a painless subcutaneous mass of 5 mm in diameter in the right labium majus at age of 21. This was excised locally at age 23, but recurred 17 months later. Although local excision was again performed, the tumor recurred and continued to enlarge very slowly. At this stage, based on the pathology of both the initial and second tumors, the diagnosis was of a benign inflammatory process. However, local recurrence and inguinal lymph node swelling occurred at age 29, and biopsy was taken. The pathology report indicated benign granulomatous changes. The slides were reconsidered and re-interpreted as epithelioid sarcoma, whereupon radical vulvectomy was performed at age 31. Vulvar epithelioid sarcoma with inguinal lymph node metastasis was first diagnosed at that time. Epithelioid sarcoma of the vulva is an exceedingly rare tumor, and only 15 cases have been reported thus far in the literature. Early diagnosis and curative treatment of this tumor may be problematic for gynecologists because of its rarity and therefore little-known characteristic clinical behavior and histology. Radical vulvectomy or extensive local excision with inguinal lymphadenectomy at the time of diagnosis is recommended as the treatment of choice.

Primary epithelioid sarcoma of the vulva

Abstract.

Kasamatsu T, Hasegawa T, Tsuda H, Okada S, Sawada M, Yamada T, Tsunematsu R, Ohmi K, Mizuguchi K, Kawana T. Primary epithelioid sarcoma of the vulva.

A case of a 31-year-old woman with epithelioid sarcoma of the vulva which metastasized to the regional lymph node 8 years after onset of the disease is reported here. The patient first noticed a painless subcutaneous mass of 5 mm in diameter in the right labium majus at age of 21. This was excised locally at age 23, but recurred 17 months later. Although local excision was again performed, the tumor recurred and continued to enlarge very slowly. At this stage, based on the pathology of both the initial and second tumors, the diagnosis was of a benign inflammatory process. However, local recurrence and inguinal lymph node swelling occurred at age 29, and biopsy was taken. The pathology report indicated benign granulomatous changes. The slides were reconsidered and re-interpreted as epithelioid sarcoma, whereupon radical vulvectomy was performed at age 31. Vulvar epithelioid sarcoma with inguinal lymph node metastasis was first diagnosed at that time. Epithelioid sarcoma of the vulva is an exceedingly rare tumor, and only 15 cases have been reported thus far in the literature. Early diagnosis and curative treatment of this tumor may be problematic for gynecologists because of its rarity and therefore little-known characteristic clinical behavior and histology. Radical vulvectomy or extensive local excision with inguinal lymphadenectomy at the time of diagnosis is recommended as the treatment of choice.

Facilitation and suppression of single striate-cell activity by spatially discrete pattern stimuli presented beyond the receptive field

Visual stimulation of a region outside the receptive field of single cells in visual cortex often results in the modulation of their responses. The modulatory effects are thought to be mediated through lateral connections within visual cortex. Research on lateral interactions commonly shows suppression. There has been no systematic study of the optimal conditions for facilitation. Here we have studied the nature of the modulation using a new type of compound stimulus: contrast reversal of pattern stimuli made of three discrete grating patches. The middle patch, optimally fitted to the receptive field in orientation, size, and spatial as well as temporal frequencies, was flanked by two similar patches presented well outside the receptive field. We found that (1) both facilitation and suppression occurred often in the same cells, when orientations of the target and flankers matched the receptive-field's optimal orientation; (2) facilitation with collinear flankers occurred most frequently at target contrasts just above the cell's firing threshold and suppression prevailed at high contrasts; (3) facilitative or suppressive modulation was obtained with target-flankers separation of up to 12 deg or more; (4) collinear facilitation was lost when flankers' orientation was rotated by 90 deg, while keeping all other parameters the same; and (5) neither the modulation mode nor the proportion of modulated cells was related to the cell types (simple vs. complex cells) and cells' laminar locations. Here we have provided physiological evidence for contrast-dependent, collinear facilitation probably underlying perceptual grouping in humans.

Colinear facilitation promotes reliability of single-cell responses in cat striate cortex

Behavior is controlled by neural activity in the brain. The final outcome of this neural control may critically depend on the firing reliability of individual neurons. A nearly constant, proportional relationship is usually found between the response mean and response variance. Here we asked whether lateral interactions within striate cortex that modulate response magnitude also proportionately modify the response variance of cortical neurons. In many cases, response variability depended on stimulus organization: discrete flankers colinearly placed well outside the neuron's receptive field increased response magnitude without a proportional increase in variance, thus improving the neuron's response reliability. Since colinear flanker facilitation is often seen near the neuron's firing threshold, increased response reliability for weak stimuli may contribute to enhancing perceptual saliency.

Contrast response characteristics of long-range lateral interactions in cat striate cortex

Single-cell responses in visual cortex to a target falling within their receptive field can be modified by collinear flanking stimuli concurrently presented outside the receptive field. Here, we report the presence of four types of contrast-dependent lateral effects: (1) facilitation at low target contrasts and suppression at high contrasts, (2) facilitation that increases with contrast, (3) suppression that increases with contrast, and (4) suppression at low contrasts with facilitation at high contrasts. We propose a sensitivity modulation model that accounts for all the four types of lateral effects by changes in two parameters. In this model, activation of neighboring neurons changes the sensitivities of the target neuron to both the direct feedforward input and inhibitory, divisive feedback from neighboring neurons.

Fine needle aspiration cytology of adenocarcinoma of the rectovaginal septum. A case report

BACKGROUND

Adenocarcinoma arising in the rectovaginal septum is exceedingly rare and is difficult to diagnose by pathologic examination prior to surgery because of the anatomic position of the tumor.

CASE

A 42-year-old woman presumed to have adenocarcinoma of the rectovaginal septum underwent fine needle aspiration for diagnosis. Although a previously performed biopsy from the posterior vaginal fornix was unsuccessful, fine needle aspiration cytology via the posterior vaginal wall detected adenocarcinoma cells. The cell clusters were composed of cells with enlarged and hyperchromatic nuclei. The nuclei themselves demonstrated round and/or irregular morphologic patterns, with high nuclear/cytoplasmic ratios, and often contained an enlarged, round nucleolus and sometimes multiple ones in a single nucleus. Aniso-nucleosis was severe, and the chromatin patterns ranged from coarse to finely granular. The cytoplasm was narrow and lightly stained. Following fine needle aspiration, the patient underwent posterior exenteration on the basis of the cytologic diagnosis.

CONCLUSION

Fine needle aspiration cytology was useful in establishing the preoperative diagnosis of adenocarcinoma of the rectovaginal septum, and curative exenterative surgery could be then performed. To our knowledge, this is the first report of fine needle aspiration cytology of adenocarcinoma at this location.

Variants of NOS1, NOS2, and NOS3 genes in asthmatics

Nitric oxide (NO) gas concentrations are higher in expired air in asthmatics. NO is synthesized by three isoforms of NO synthase (NOS) encoded by three distinct genes, NOS1, NOS2, and NOS3. Genome-wide searches have identified linkages to asthma on chromosomes 7, 12, and 17 where these three genes are localized. No association study, however, has been reported to date. To test whether variants of NOS1, NOS2, and NOS3 relate to asthma, a genetic association study was conducted in a British population (n = 300). Intragenic microsatellite variants of NOS1 were significantly associated with asthma [odds ratio (OR) = 2.08, 95% CI: 1.20-3.57 (95% CI), P = 0.008 (Pc = 0.048)], but not with IgE levels. Neither NOS2 nor NOS3 variants showed any association with asthma nor IgE levels. These findings suggest that NOS1 variants may be a significant contributor to asthma in a British population.

Effect of hormone replacement therapy on the bone mass and urinary excretion of pyridinium cross-links

CONTEXT

The menopause accelerates bone loss and is associated with an increased bone turnover. Bone formation may be evaluated by several biochemical markers. However, the establishment of an accurate marker for bone resorption has been more difficult to achieve.

OBJECTIVE

To study the effect of hormone replacement therapy (HRT) on bone mass and on the markers of bone resorption: urinary excretion of pyridinoline and deoxypyridinoline.

DESIGN

Cohort correlational study.

SETTING

Academic referral center.

SAMPLE

53 post-menopausal women, aged 48-58 years.

MAIN MEASUREMENTS

Urinary pyr and d-pyr were measured in fasting urine samples by spectrofluorometry after high performance liquid chromatography and corrected for creatinine excretion measured before treatment and after 1, 2, 4 and 12 months. Bone mineral density (BMD) was measured by dual energy X-ray absorptiometry (DEXA) before treatment and after 12 months of HRT.

RESULTS

The BMD after HRT was about 4.7% (P < 0.0004); 2% (P < 0.002); and 3% (P < 0. 01) higher than the basal values in lumbar spine, neck and trochanter respectively. There were no significant correlations between pyridinium cross-links and age, weight, menopause duration and BMD. The decrease in pyr and d-pyr was progressive after HRT, reaching 28.9% (P < 0.0002), and 42% (P < 0.0002) respectively after 1 year.

CONCLUSIONS

Urinary pyridinoline and deoxypyridinoline excretion decreases early in hormone replacement therapy, reflecting a decrease in the bone resorption rate, and no correlation was observed with the bone mass evaluated by densitometry.

Stroke incidence and case fatality in Shiga, Japan 1989-1993

BACKGROUND

This paper describes incidence rates and case-fatality for sub-types of stroke using data collected in Takashima, Shiga, Japan, from 1989 to 1993 and compares these with similar registers in other parts of Japan.

METHODS

Registered patients included all residents of the county who experienced a first-ever stroke. Stroke was defined as sudden onset of neurological symptoms which continued for a minimum of 24 hours or led to death. Almost all such patients are hospitalized in this country. Early case fatality was defined as patients who died within 28 days of stroke onset. Diagnosis of stroke type was based on clinical symptoms as well as computed tomography (CT) scans.

RESULTS

Age-adjusted incidence rates for stroke per 100,000 population aged 35 years and older were 268.7 for men and 167.5 for women. The age-specific incidence rate of both cerebral infarction and cerebral haemorrhage increased with advancing age. The occurrence of cerebral infarction in men was twice as high as in women. The 28-day case fatality for all sub-types of stroke was 16.1% in men and 15.8% in women. Case fatality for cerebral infarction, cerebral haemorrhage, and subarachnoid haemorrhage was 10.7%, 22.4% and 28.6% respectively.

CONCLUSIONS

Takashima County has a moderately high stroke incidence rate and case fatality compared with other similar studies in Japan. The incidence rate of cerebral infarction in men is twice that in women, while other sub-types of stroke showed smaller differences. In order to decrease the incidence of stroke in Japan, greater efforts at primary prevention will be necessary, in particular, it is important to prevent cerebral infarction in men.

1.50-mum-band gain-shifted thulium-doped fiber amplifier with 1.05- and 1.56-mum dual-wavelength pumping

We propose and demonstrate a 1.50-mum- band gain-shifted thulium-doped fiber amplifier (TDFA) by using a novel dual-wavelength (1.05and1.56 -mum) pumping scheme for what we believe is the first time. By providing a small amount of 1.56-mum power to a conventional upconversion-pumped TDFA, we successfully demonstrated a small-signal gain larger than 25 dB and a noise figure of 5 dB in a 1475-1510-nm band.

Clinicopathological study of recurrent uterine cervical squamous-cell carcinoma

OBJECTIVE

To improve prognoses of patients with recurrent uterine cervical squamous-cell carcinoma.

PATIENTS AND METHODS

We clinicopathologically analyzed 464 patients with uterine cervical squamous-cell carcinoma (126 positive, 338 negative pelvic lymph-node metastasis) who were treated at the Saitama Cancer Center from January 1, 1976 to December 31, 1991.

RESULTS

The recurrence rates of negative pelvic lymph-node metastasis patients were 14. 2% (39/274) in pT1b and 32.8% (21/64) in pT2b. But for positive lymph-node metastasis patients the rates were 39.0% (23/59) in pT1b and 58.2% (39/67) in pT2b. The interval to recurrence was shorter in positive pelvic lymph-node patients than in negative patients. The 5-year survival rates after relapse of negative lymph-node patients with intrapelvic, extrapelvic, and both-sites recurrence were 53, 12, and 40%, respectively. But among distant recurrent sites, lung metastasis in negative lymph-node patients and lymphatic tract metastasis brought relatively fair prognoses.

CONCLUSIONS

Regular long-term checks are necessary and active retreatments are recommended for patients with local recurrences, lung metastasis, or lymphatic vessel metastatic lesions.

Analysis of initial failure site and spread pattern in endometrial carcinoma: a Japanese experience

Kasamatsu T, Shiromizu K, Takahashi M, Matsumoto K, Shirai T. Analysis of initial failure site and spread pattern in endometrial carcinoma: a Japanese experience. This retrospective study was undertaken in an attempt to identify initial failure sites and spread patterns in patients with endometrial carcinoma in Japan. A retrospective clinicopathologic review of 272 patients treated from 1983 to 1994 at Saitama Cancer Center was performed. Patients underwent total hysterectomy, bilateral salpingo-oophorectomy and pelvic lymphadenectomy. Postoperative external radiation was given to the patients with deep myometrial invasion, high grade tumor, and/or lymph node metastasis. Following surgery, chemotherapy was given to the patients with extrapelvic metastasis. Of the 272 patients, 262 had no residual disease after initial treatment and 10 had confirmed residual disease. Of the 262 patients, 32 (12.2%) suffered recurrence. The recurrence rates for stage I, II, III, and IV were 5.6% (10/178), 5.7% (2/35), 35.3% (18/51), and 100% (2/2), respectively. Of the 32 patients who failed, 6 (18.8%) experienced local failure, 13 (40.6%) had distant failure without peritoneal spread, and 13 (40.6%) had distant failure with peritoneal spread. In distant failure, the incidence of peritoneal spread was highest (50.0%, 13/26), closely followed by that of pulmonary metastasis (46.2%, 12/26). Furthermore, of those patients with residual disease, peritoneal spread was found in 80% (8 of 10). Five of the six patients (83.3%) with local failure survive, but all patients with peritoneal spread have died. Peritoneal dissemination is an important failure pattern and should be considered a top priority in an attempt to improve survival in patients with endometrial carcinoma.

Biochemical markers of bone turnover and bone loss at the lumbar spine and femoral neck: the Taiji study

The purpose of this study was to ascertain whether biochemical markers of bone turnover predict bone loss. The survey was carried out in Taiji, Wakayama Prefecture, Japan. From a list of inhabitants aged 40-79 years, 400 participants (50 men and 50 women in each of four age groups) were selected randomly. Bone mineral density (BMD) was measured, and blood and urine samples of all participants were examined to obtain values for eight biochemical markers: alkaline phosphatase (ALP), bone Gla protein (BGP), type I procollagen (carboxyterminal peptide of type I procollagen; PICP), cross-linked carboxyterminal telopeptide region of type I collagen (ICTP), and urinary excretion of calcium (Ca), phosphate (P), pyridinoline (Pyr), and deoxypyridinoline (D-Pyr). Each marker was evaluated as a predictor of the rate of bone change in lumbar spine and femoral neck BMD over a 3-year period. The value of Pyr was significantly related to the change of lumbar spine BMD in men (P = 0.009), and that of BGP was found to be significant in women (P = 0.045). By contrast, none of the bone markers significantly correlated with bone loss at the femoral neck. The coefficient of determination at the lumbar spine was 5% and 7% at the femoral neck only. We conclude that biochemical markers of bone turnover cannot predict bone loss rates in middle-aged or elderly Japanese men and women over a 3-year period with sufficient accuracy for use in clinical decision making.

Temperature dependence and optimization of 970-nm diode-pumped Yb:YAG and Yb:LuAG lasers

We have investigated the temperature dependence of output performances for 970-nm diode-pumped Yb:YAG (Yb(3+):Y(3)Al(5)O(12)) and Yb:LuAG (Yb(3+):Lu(3)Al(5)O(12)) lasers over the wide temperature range from 80 to 310 K. Temperature-optimized operation was experimentally demonstrated at around 160 K and was theoretically confirmed by taking into account the absorption spectra change of Yb crystals at low temperatures. Cooling the crystal to below 160 K caused a narrowing of the absorption bandwidth and led to a decrease in output power and efficiency.

Restoration of ocular dominance plasticity mediated by adenosine 3',5'-monophosphate in adult visual cortex

Noradrenaline (NA)-stimulated beta-adrenoreceptors activate adenylate cyclase via excitatory G-proteins (Gs). Activated adenylate cyclase in turn promotes the production of cAMP. Critical roles of cAMP-dependent protein kinase A (PKA) in divergent cellular functions have been shown, including memory, learning and neural plasticity. Ocular dominance plasticity (ODP) is strongly expressed in early postnatal life and usually absent in the mature visual cortex. Here, we asked whether the activation of cAMP-dependent PKA could restore ODP to the aplastic visual cortex of adult cats. Concurrent with brief monocular deprivation, each of the following cAMP-related drugs was directly and continuously infused in the adult visual cortex: cholera toxin (a Gs-protein stimulant), forskolin (a Gs-protein-independent activator of adenylate cyclase) and dibutyryl cAMP (a cAMP analogue). We found that the ocular dominance distribution became W-shaped, the proportion of binocular cells being significantly lower than that in respective controls. We concluded that the activation of cAMP cascades rapidly restores ODP to the adult visual cortex, though moderately. The finding further extends the original hypothesis that the NA-beta-adrenoreceptors system is a neurochemical mechanism of cortical plasticity.