Postprandial middle cerebral arterial vasoconstriction in cirrhotic patients. A placebo, controlled evaluation

BACKGROUND/AIMS

The objective of this study was to determine whether cerebral arterial vasoconstriction occurs in relation to postprandial splanchnic blood pooling in cirrhotic patients.

METHODS

The pulsatility and the resistive indexes and blood flow in the middle cerebral artery were measured by magnetic resonance imaging in 21 cirrhotics and 14 controls. These measurements were repeated 30 min after ingestion of a 400 kcal liquid meal or placebo. Seven controls and 14 patients received the meal, and seven controls and seven patients received placebo.

RESULTS

In the fasting conditions, cirrhotics had a greater pulsatility index (0.81 +/- 0.10 vs. 0.67 +/- 0.05, P < 0.001) and a greater resistive index (0.61 +/- 0.04 vs. 0.53 +/- 0.04, P < 0.001) and a lower blood flow (127 +/- 42 ml/min vs. 167 +/- 37 ml/min, P < 0.03) in the middle cerebral artery compared with controls. Meal ingestion significantly increased the pulsatility index (P < 0.03) and the resistive index (P < 0.01) and decreased blood flow (P < 0.03) in the middle cerebral artery in cirrhotics but not in controls. In contrast, placebo ingestion had no effect on the hemodynamic parameters in the middle cerebral artery in the two groups.

CONCLUSIONS

Results support the hypothesis that middle cerebral arterial vasoconstriction seen in cirrhotic patients is one of the cerebral artery's homeostatic responses to underfilling of the splanchnic arterial circulation.

Tumor budding and fibrotic focus-proposed grading system for tumor budding in invasive carcinoma no special type of the breast

Tumor budding grade is a very useful histological prognostic indicator for colorectal cancer patients. Recently, it has been also reported as a significant prognostic indicator in invasive breast carcinoma patients. Our group and others have previously reported that the presence of a fibrotic focus in the tumor is a very useful histological finding for accurately predicting the prognosis in patients with invasive carcinoma of no special type (ICNST) of the breast. The purpose of the present study was to investigate whether a grading system incorporating tumor budding in a fibrotic focus is superior to the conventional grading system for tumor budding to accurately predict outcomes in patients with ICNST. According to our new grading system, we classified the tumors into grade I (164 cases), grade II (581 cases), and grade III (110 cases), and the results clearly demonstrated the significant superiority of the new grading system over that of conventional tumor budding alone for accurately predicting outcomes in patients with ICNST. Our findings strongly suggest that tumor cells and tumor-stromal cells interaction play very important roles in tumor progression rather than tumor cells alone.

Vimentin-positive invasive breast carcinoma of no special type: A breast carcinoma with lethal biological characteristics

Vimentin is a stable mesenchymal immunohistochemical marker and is widely recognized as a major marker of mesenchymal tumors. The purpose of the present study was to investigate if the vimentin expression status might serve as a significant predictor of outcomes in patients with invasive breast carcinoma of no special type (IBC-NST) and to investigate, by comprehensive RNA sequencing analyses, the mechanisms involved in the heightened malignant potential of vimentin-positive IBC-NSTs. This study, conducted using the data of 855 patients with IBC-NST, clearly identified vimentin expression status as a very important independent biological parameter for accurately predicting the outcomes in patients with IBC-NST. RNA sequence analyses clearly demonstrated significant upregulation of coding RNAs known to be closely associated with cell proliferation or cellular senescence, and significant downregulation of coding RNAs known to be closely associated with transmembrane transport in vimentin-positive IBC-NSTs. We conclude that vimentin-positive IBC-NSTs show heightened malignant biological characteristics, possibly attributable to the upregulation of RNAs closely associated with proliferative activity and cellular senescence, and downregulation of RNAs closely associated with transmembrane transport in IBC-NSTs.

Proactive Symptom Monitoring by Pharmacists Using a Cancer Patient Support App in Out-patient Oral Multi-kinase Inhibitor Therapy: Feasibility Study of a Small Patient Population

BACKGROUND/AIM

Measures to control adverse events (AEs) in the use of oral multi-kinase inhibitors (OMI) are important for the continuation of treatment.

PATIENTS AND METHODS

In this study, oncology pharmacists monitored symptoms of patients receiving outpatient therapy with OMIs in real-time using a smartphone Web app for the early detection/early treatment of AEs. This feasibility study evaluated the effects of using the app in 10 patients compared with data from 10 patients who did not use the app.

RESULTS

In the app group, grade 3 AEs were reported in all patients on the day of their occurrence. In contrast, in the no-app group, it took 1-22 days for pharmacists to detect these AEs, among whom 2 patients needed emergency consultations and admissions due to grade 3 AEs. In the app group, 1 patient had an emergency consultation, without admission. The percentage of patients requiring 10 minutes or more for symptom checking during the interview before the physician's examination was significantly lower (p=0.001), and the frequency of telephone calls was also significantly lower (p=0.029) in the app group compared to the no app group.

CONCLUSION

Using the Web app facilitates the early detection of AEs, contributing to reducing the need for emergency consultations and admissions, and minimizing the time pharmacists spend confirming symptoms with patients.