Background:Recent trends in the clinical characteristics, management and prognosis of dilated cardiomyopathy (DCM) remain to be examined in Japan.Methods and Results:We compared 306 and 710 DCM ...patients in the Chronic Heart Failure Analysis and Registry in the Tohoku District (CHART)-1 (2000–2005, n=1,278) and the CHART-2 (2006–present, n=10,219) Studies, respectively. Between the 2 groups of DCM patients, there were no significant differences in baseline characteristics. The prevalence of hypertension, dyslipidemia and diabetes mellitus were all significantly increased from the CHART-1 to the CHART-2 Study. The use of β-blockers and aldosterone antagonists was significantly increased, while that of loop diuretics and digitalis was significantly decreased in the CHART-2 Study. The 3-year mortality rate was significantly improved from 14% in the CHART-1 to 9% in the CHART-2 Study (adjusted HR, 0.60; 95% CI: 0.49–0.81; P=0.001). In particular, 3-year incidence of cardiovascular death was significantly decreased (adjusted HR, 0.26; 95% CI: 0.14–0.50, P<0.001), while that of HF admission was not (adjusted HR, 0.90; 95% CI: 0.59–1.37, P=0.632). The prognostic improvement was noted in patients with BNP <220 pg/ml, LVEF>40%, β-blocker use and aldosterone antagonist use.Conclusions:Long-term prognosis of DCM patients has been improved, along with the implementation of evidence-based medication in Japan. (Circ J 2015; 79: 1332–1341)
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Background: Perioperative chemotherapy with FOLFOX4 reduces the progression-free survival of patients with liver metastases from colorectal cancer. However, the benefit of ...adjuvant treatment after hepatectomy has not been clarified yet. Here, we evaluated the efficacy of treatment with mFOLFOX6 in a postoperative adjuvant setting. Methods: We recruited 49 patients from 17 hospitals (Japan) between July 2006 and June 2009 who were histologically proved to have colorectal cancer. The primary tumor had to be resected with R0 or R1 resection, and no detectable extrahepatic metastases. This report is the trial’s final data for progression-free survival (PFS) in all enrolled cases, while overall survival is still being monitored. The regimen was 12 cycle of mFOLFOX6. The primary endpoint was progression-free survival. This study was planned to detect a 20% increase in median PFS from 40% to 60% in all assigned patients based on the data of several previous surgeries, and the set of 50 cases. Results: 1 patient did not start the protocol treatment because liver metastases were detected before starting. 48 patients started the protocol treatment. 4 patients committed a protocol violation. Excluding this 4 violation cases from the 49 cases, 33 cases (75%) received 10 course (83.3%) of mFOLFOX6. The dose intensities of oxaliplatin, leucovorin, and 5-FU were 75.9%, 80.5%, 78%, respectively in all enrolled cases. The PFS at 2 years was 59.2%. The median survival time was 49 months. The PFS for single liver metastasis was better than that for multiple metastases (Wilcoxon test: p<0.05). Overall survival was 72%. There were no Grade 4 adverse events (AE) or deaths related to chemotherapy. In Grade 3 AE, neutropenia, sensory disturbance, thrombocytopenia, and allergy were 37.5%, 8.3%, 8.3%, and 8.3%, respectively. Conclusions: Adjuvant treatment with mFOLFOX6 is feasible and could greatly improve the PFS without biologics. The benefit of this therapy with mFOLFOX6 as an adjuvant treatment needs to be evaluated further as compared to perioperative chemotherapy.
To elucidate the potential effects of prostate deformation on dose distribution during Iodine-125 ((125)I) seed implantation brachytherapy for prostate cancer.
A retrospective analysis of 245 ...patients who underwent only transperineal brachytherapy for low-risk prostate adenocarcinoma was performed. The maximum diameters of the prostate were measured before treatment by transrectal ultrasound volumetry along right to left (RL), anterior to posterior (AP), and apex to base (Length) directions. The seeds were inserted by the modified peripheral loading method using real-time ultrasound-guided seed placement. The ellipsoid deformation rates in the axial plane (E(ax)) and in the sagittal plane (E(sag)) were defined as RL-AP/RL and Length-AP/Length, respectively. The correlation between them and the dose-volume histogram parameters at 30 days after the operation was evaluated. A simulation test was additionally performed to ascertain the change in dose distribution among virtual volumes built in a radiotherapy planning device that corresponds to prostates with increased Eax or Esag.
The mean Esag and Eax of patients were 0.313 (range, -0.28 to 0.844) and 0.261 (range, -0.02 to 0.54), respectively. Esag showed a positive correlation with dose (Gy) covering 90% of the prostate volume (pD(90)), prostate volume (%) covered by 100% of the prescribed dose (pV(100)), the rectal volume (cc) irradiated by 100% of the prescribed dose (rV(100)), and the rectal volume (cc) irradiated by 150% of the prescribed dose (rV(150)), whereas Eax showed a positive correlation with prostate volume (%) covered by 150% of the prescribed dose (pV(150)) and the urethral dose (Gy) delivered to 5% of its volume (uD(5)). The simulation test suggested that the prescribed dose resulted in the best coverage in patients with increased E(sag), and that patients with increased E(ax) exhibited poor urethral sparing from overdosage.
In the seed implantation method, ellipsoid deformation of the prostate causes higher rectal dose exposure or dose delivery to the urethra.
Aim The effect of rapid-acting insulin secretagogues (glinides) on glycemic control when included with insulin therapy for type 2 diabetes remains uncertain. To examine this, we added glinide once a ...day to twice daily injections of premixed insulin. Research Design and Methods Seventy-four type 2 diabetic patients, taking twice daily injections of premixed insulin and whose diabetic control was stable, were registered at 6 independent institutions. After a 3-month observation period, 60 patients were administered 10 mg mitiglinide or 90 mg nateglinide at lunchtime without changing their insulin regimen. After 12 weeks, administration of glinide was discontinued and observation was continued. HbA1c levels were measured at the start of glinide administration, after 12 weeks of glinide , and at 12 weeks after discontinuation. Results HbA1c improved from 7.72±0.66% to 7.55±0.71% (p <0.01) at Week 12 of glinide administration. Twelve weeks after discontinuation, HbA1c returned to the baseline level (7.72±0.81%). Conclusion This study indicates that the addition of glinide once a day at lunchtime to twice daily injections of premixed insulin is effective for the treatment of type 2 diabetes.
Background:The risk of patients with aortic stenosis (AS) should be stratified not only by AS severity but also by comorbidities.Methods and Results:We aimed to develop a risk score for mortality in ...412 patients with AS (pressure gradient ≥30 mmHg, mean age 74.9 years, male 52.4%) in the CHART-2 Study (n=10,219). During a 3-year follow-up, 73 (17.7%) patients died. Crude 3-year mortality of patients in New York Heart Association (NYHA) classes I, II, and III/IV was 9.5%, 16.5%, and 49.7%, respectively (P<0.001). Stepwise Cox regression analysis showed that the combination of 7 factors was the best model to predict the mortality of AS patients, who were scored according to their hazard ratios, including NYHA class III–IV (score 6), male sex (3), serum albumin level ≤4 g/dl (2), aortic peak flow ≥4.5 m/s (2), age ≥75 years (2), chronic kidney disease (2), and anemia (1). Receiver-operating characteristic analysis showed excellent association between the sum of the scores and 3-year mortality (area under the curve, 0.78). The multivariate Cox proportional hazard model demonstrated that the present risk score also well stratified the mortality risk.Conclusions:The present study demonstrates that, in addition to the classical prognostic factors related to symptoms and AS severity, various comorbidities are associated with mortality. Thus, the present comprehensive risk score may be useful for risk stratification of AS patients. (Circ J 2015; 79: 1631–1638)
To establish a method of quantitative assessment of the duodenal exposure dose to avoid duodenal morbidity after radiotherapy for bile duct cancer.
After external beam radiotherapy (ERTx) and ...intraluminal high-dose-rate brachytherapy (BRTx), 4 of 10 patients developed Grade 3 or 4 ulcers at the posterior wall of the duodenal bulb (PWDB) (compromised group); the remainder exhibited no duodenal complications (spared group) for 14 (range, 7-59) months after radiotherapy. The radiation exposure to the duodenal volume at risk (V(duod)) in ERTx and BRTx was individually analyzed using dose-volume histograms in terms of the mean doses (the average dose of V(duod)D(ave) and the median dose of V(duod) D(median)), dose covering 1% or 5% of V(duod) (dose covering 1% of the V(duod) D(1) and dose covering 5% of the V(duod) D(5), respectively), and the V(duod) receiving 100% or 150% of the prescribed radiation dose (V(100) and V(150), respectively) in ERTx (D(ave), D(median), D(5)) and BRTx (D(ave), D(1), D(5), V(100), V(150)). D(ave) and D(5) were converted to biologically effective doses (BEDs), and each corresponding values of ERTx and BRTx were summed presenting as BED(ave_sum) and BED(5_sum).
The PWDB was consistently involved in 100% of the prescription dose area in ERTx. The compromised group had smaller exposure doses without significant difference (SD). In BRTx, the PWDB was exposed to higher doses. The compromised group had larger dose exposures without SD and larger volume exposures (V(100), V(150)) with SD in BRTx. The BED(ave_sum) and BED(5_sum) showed no difference between the groups.
Measuring the duodenal volume exposed to determine doses that exceed the prescription in BRTx may be useful for predicting intractable complications in the combined radiotherapy.
Purpose: The correlation between the frequency of spontaneous and radiation-induced apoptosis, and the precedence between those for predicting prognosis were studied at clinical level.
Methods and ...Materials: Twenty-one patients (mean age, 65.8 years; 16 men and 5 women) with bladder cancer (transitional cell carcinoma Grade 3, T3bN0M0, Stage IIIb) underwent intraoperative radiotherapy: single 30-Gy 12-MV electron beam irradiation to bladder, followed by total cystectomy 6 h after irradiation. The specimens of pretreatment and irradiated bladder cancer were assayed for apoptosis, using TUNEL staining with counter staining of hematoxylin. The apoptotic index (AI) was calculated by dividing the number of apoptotic cells by the total number of cells and multiplying by 100. The Pearson’s linear fitting was used to test the correlation between spontaneous and radiation-induced apoptosis. The Kaplan–Meier product-limit estimation was used for overall survival (OS) and freedom from recurrence (FFR). The precedence between spontaneous and radiation-induced apoptosis for predicting the clinical prognosis was estimated using the proportional hazard regression.
Results: The mean AI of spontaneous and radiation-induced apoptosis was 1.18 ± 0.16 and 2.63 ± 0.45, respectively, which was significantly different. There was strong correlation between spontaneous and radiation-induced apoptosis (
r
2 = 0.864, adjusted
r
2 = 0.857). Radiation-induced apoptosis was estimated by equitation:
y (radiation-induced apoptosis) = 2.67 × (spontaneous apoptosis) −0.52. However, the proportional hazard regression test indicated that only spontaneous apoptosis was significant for predicting OS and FFR (|t| > 0.2), but radiation-induced apoptosis was not.
Conclusion: Estimating AI in radiation-induced apoptosis from AI in spontaneous apoptosis is possible. However, spontaneous apoptosis is more accurate in predicting clinical prognosis.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Hypoxic cells play a key role in the radioresistance of malignant glioma. Interferon-beta, ACNU as nimustine hydrochloride and radiotherapy (IAR) is a common therapy for malignant glioma in Japan. ...Since hyperbaric oxygenation (HBO) increases oxygen pressure in glioma tissue, we applied a modified IAR therapy, radiotherapy after HBO combined with interferon-beta and ACNU (HBO/IAR therapy), for supratentorial malignant gliomas. Daily radiation therapy was completed within 15 min after HBO. We assessed HBO/IAR with respect to toxicity, response rates and the time of tumor progression (TTP). We also examined the incidence of responses by some prognostic factors before HBO/IAR, namely, age, Karnofsky performance scale (KPS), histological type, tumor size, tumor site and operation type. Of 39 patients who participated in this study, 35 underwent a complete schedule of HBO/IAR therapy in which toxicity was permissible. Thirty patients (76.9%) either maintained or increased KPS during HBO/IAR with a mean duration of 68 +/- 14 days. The response rates (CR + PR%) for glioblastoma, anaplastic astrocytoma and overall were 50%, 30% and 43%, respectively. The incidence of therapeutic responses among all prognostic factors before HBO/IAR did not significantly differ. Median TTP for patients with glioblastoma, patients with anaplastic astrocytoma, and overall were 38, 56 and 43 weeks, respectively. The present study suggested that HBO/IAR therapy could be applied to especially patients with poor prognostic factors, because of its short treatment period, its permissible toxicity and identical response to patients with good prognostic factors.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OBVAL, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
Purpose: Curative resection is the only chance for long-term survival for pancreatic carcinoma, however, the surgical results remain poor. Even after resection with a microscopically negative margin ...(R0), prognostic factors and predictors of recurrence are needed. Several reports revealed that sustained elevation of tumor markers (TM) after surgery is related to poor prognosis. A questionnaire survey to evaluate perioperative TM status as a prognostic factor for resected pancreatic carcinoma was conducted among Miyagi-HBPCOG institutions in the period from 2003 to 2007. Method: Of 333 cases collected, clinicopathological data including age, gender, operative procedure, TM, and adjuvant therapy from histologically confirmed 294 cohorts in which both pre- and post- operative TM measurements were analyzed by stratification of 3 groups depending on TM status (without increase, with normalization after surgery, with sustained elevation). Results: About 80% of all cohorts had elevated TM and half of them had sustained elevation of postoperative TM. Median survival of the group without elevation of preoperative TM, the group with normalization of postoperative TM, and the group with sustained elevation of postoperative TM were 36.4 months, 24.5 months, and 16.8 months, respectively (P<0.0001). Stage and sustained elevation of postoperative TM had a significant impact on overall survival. By subgroup analyses in the cases with R0 resection, patients with sustained elevation of postoperative TM had significantly poorer survival than those with normalized TM or without elevation of TM. Conclusion: These data showed that sustained elevation of serum tumor markers after resection is an important prognostic factor for pancreatic cancer.
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