Background
Patients' quality of life (QoL) deteriorates remarkably after gastrectomy. Billroth I reconstruction following distal gastrectomy has the physiological advantage of allowing food to pass ...through the duodenum. It was hypothesized that Billroth I reconstruction would be superior to Roux‐en‐Y reconstruction in terms of long‐term QoL after distal gastrectomy. This study compared two reconstructions in a multicentre prospective randomized clinical trial to identify the optimal reconstruction procedure.
Methods
Between January 2009 and September 2010, patients who underwent gastrectomy for gastric cancer were randomized during surgery to Billroth I or Roux‐en‐Y reconstruction. The primary endpoint was assessment of QoL using the Functional Assessment of Cancer Therapy – Gastric (FACT‐Ga) questionnaire 36 months after surgery.
Results
A total of 122 patients were enrolled in the study, 60 to Billroth I and 62 to Roux‐en‐Y reconstruction. There were no differences between the two groups in terms of postoperative complications or mortality, and no significant differences in FACT‐Ga total score (P = 0·496). Symptom scales such as epigastric fullness (heaviness), diarrhoea and fatigue were significantly better in the Billroth I group at 36 months after gastrectomy (heaviness, P = 0·040; diarrhoea, P = 0·046; fatigue, P = 0·029). The rate of weight loss in the third year was lower for patients in the Billroth I group (P = 0·046).
Conclusion
The choice of anastomotic reconstruction after distal gastrectomy resulted in no difference in long‐term QoL in patients with gastric cancer. Registration number: NCT01065688 (http://www.clinicaltrials.gov).
No difference between reconstructions
The conditioning of cortical excitability by transcranial magnetic stimulation (TMS) has become a valuable technique to promote recovery of motor function after stroke. As TMS is not used in all ...patients, we investigated the hypothesis that peripheral stimulation may have an adjustment effect on motor cortical excitability. Our experimental paradigm was divided into three phases. In the first phase, TMS was delivered to the left or right primary motor cortex to induce a motor evoked potential (MEP) from the contralateral first dorsal interosseous muscle. The measured MEPs in this phase were used to evaluate the effect of peripheral stimulation. In the second phase, 1 Hz magnetic stimulation was applied over the contralateral or ipsilateral forearm for motor cortex as peripheral stimulation. In the third phase, the MEP was evoked by TMS and recorded using the same setting as the first phase. We found that a decrease in MEP amplitude was observed in the left motor cortex following peripheral stimulation over the right forearm. By contrast, the MEP amplitude was not altered in the right motor cortex by peripheral stimulation over the left forearm. An increase in MEP amplitude was observed in the ipsilateral motor cortex induced by peripheral stimulation over the left or right forearm. We also found that by changing the MEP amplitude, the motor cortex excitability varied according to magnetic stimulation of the forearm. These data suggest that peripheral stimulation may have an adjustment effect on motor cortical excitability, via changes in the stimulus site.
To estimate the survival process of Pacific bluefin tuna Thunnus orientalis during the larval period, estimated growth histories were compared between larvae collected in late spring and juveniles ...collected in the boreal summer of 2004, which were considered to be survivors of the larval cohorts. Larval tuna (3.3 to 9.6 mm standard length, SL) were collected from mid-May to early June around the Ryukyu Islands, northwestern Pacific Ocean, and juvenile tuna were collected offshore of Kochi and Nagasaki prefectures in July- August. Preflexion, flexion and postflexion larvae were collected, and their ages ranged from 4 to 18 d. Back-calculated SLs by the biological intercept method showed that larval tuna in the postflexion phase were larger-at-age than preflexion and flexion larvae, suggesting that only larger and faster growing larvae were able to survive to the postflexion phase. The logarithms of otolith radii (ln OR: proportional to SL) of larvae with slower growth and development were smaller than the minimum ln OR of surviving juvenile tuna, which indicated the smallest possible size required for larvae to successfully recruit to the fishery. These results indicate that the survival of larvae of Pacific bluefin tuna depends largely on size and growth rates during early life history.
SUMMARY
Squamous cell carcinoma of the esophagus (SCCE) has a poor prognosis compared with other gastrointestinal cancers. Many patients present with locoregional unresectable or metastatic disease ...at the time of diagnosis. For these patients with metastatic esophageal cancer, chemotherapy is generally indicated. The aim of this phase I/II study was to evaluate the efficacy and safety of the combined use of docetaxel, cisplatin (CDDP) and 5-fluorouracil (5-FU)(DCF) in patients with recurrent/metastatic SCCE. This study adopted divided doses of docetaxel and CDDP in order to reduce the toxicities of the treatment. The dose of docetaxel was escalated using the following protocol in the phase I stage: level 1, 30 mg/m2; level 2, 35 mg/m2 and level 3, 40 mg/m2, which was intravenously infused for 2 hours on days 1 and 8. CDDP was administered at a dose of 12 mg/m2 infused for 4 hours on days 1–5. The 5-FU was administered at a dose of 600 mg/m2 continuously infused from day 1 to 5. This regimen was repeated every 4 weeks. The study subjects were nine patients (phase I) and 48 patients (phase II). The recommended dose was determined as level 3 in phase I. In the phase II stage, the overall response rate was 62.5%, with a complete response rate of 12.5%. The median progression-free survival was 6 months, and the median overall survival was 13 months. Grade 3/4 toxicities of leukopenia, neutropenia and febrile neutropenia occurred in 64.6%, 68.8% and 14.6% of the patients, while grade 3/4 non-hematological toxicities were relatively rare. No treatment-related death was recorded. This modified DCF regimen with divided doses can be a tolerable and useful regimen of definitive chemotherapy for unresectable SCCE because of its high efficacy, although adequate care for severe neutropenia must be administered.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
The variation of velocity and volume transport of the Tsugaru Warm Current (TWC) is investigated based on the data of continuous and cross‐sectional current monitoring in the Tsugaru Strait. During ...November 1999–March 2000, the structure of the velocity transection across the strait was almost stable in which the TWC occupied the central part of the strait, while the returning flows existed in the northern and southern part of the strait, and the velocity of these flows decreases with time. The volume transport of the TWC varies from 2.1 to 1.1 Sv, with the mean value of 1.5 Sv, following the variation of the TWC. The temporal variation of the volume transport shows a linear correlation with that of the sea level difference between the Japan Sea and the Pacific Ocean. The contribution of the sea level difference to the volume transport is estimated to be roughly 70%.
Adult T-cell leukemia/lymphoma (ATL) is a malignancy of mature T lymphocytes caused by human T-lymphotropic virus type I. Intensive combination chemotherapy and allogeneic hematopoietic stem cell ...transplantation have been introduced since the previous Japanese nationwide survey was performed in the late 1980s. In this study, we delineated the current features and management of ATL in Japan. The clinical data were collected retrospectively from the medical records of patients diagnosed with ATL between 2000 and 2009, and a total of 1665 patients' records were submitted to the central office from 84 institutions in Japan. Seventy-one patients were excluded; 895, 355, 187, and 157 patients with acute, lymphoma, chronic, and smoldering types, respectively, remained. The median survival times were 8.3, 10.6, 31.5, and 55.0 months, and 4-year overall survival (OS) rates were 11%, 16%, 36%, and 52%, respectively, for acute, lymphoma, chronic, and smoldering types. The number of patients with allogeneic hematopoietic stem cell transplantation was 227, and their median survival time and OS at 4 years after allogeneic hematopoietic stem cell transplantation was 5.9 months and 26%, respectively. This study revealed that the prognoses of the patients with acute and lymphoma types were still unsatisfactory, despite the recent progress in treatment modalities, but an improvement of 4-year OS was observed in comparison with the previous survey. Of note, one-quarter of patients who could undergo transplantation experienced long survival. It is also noted that the prognosis of the smoldering type was worse than expected.
•An improvement of 4-year OS for acute and lymphoma types of ATL was observed in comparison with that of the 1991 report.•The prognosis of the smoldering type ATL was worse than expected from the 1991 report.
Tumor-specific gene delivery is crucial to achieving successful effects in suicide gene therapy. Carcinoembryonic antigen (CEA) promoter has been widely used for this purpose, but the expression ...level of tumor-specific promoters such as CEA promoter is generally low. In the previous study, we used the Cre/loxP system and showed that LacZ expression by the CEA promoter was remarkably enhanced and maintained its specificity using the Cre/loxP regulation system. In this study, the Cre/loxP system was first applied to augmentation of selective expression of the cytosine deaminase (CD) gene as a suicide gene therapy in CEA-producing cells. The double infection with AxCEANCre expressing Cre recombinase under the control of the CEA promoter and AxCALNLCD expressing the CD gene under the control of the CAG promoter by the Cre switching system rendered CEA-producing tumor cells 13-fold more sensitive to 5-fluorocytosine (5-FC) compared with the single infection with AxCEACD expressing CD gene driven by the CEA promoter. The therapeutic efficacy of the enhanced CD/5-FC suicide gene therapy was evaluated in orthotopic implantation models of human gastric carcinoma. Adenovirus vectors (1 x 10(9) plaque-forming units) were administered i.p. into mice three times, and then 5-FC was administered i.p. for the next 10 days. Tumor volume and weight in mice treated with AxCEANCre and AxCALNLCD/5-FC were significantly reduced as compared with those in mice treated not only with Mock (AxCALacZ) but also with AxCEACD/5-FC (P < 0.0001). This beneficial effect on tumor burden was also reflected in the overall survival. The survival periods of the mice treated with AxCEANCre and AxCALNLCD/5-FC were longer than those of mice treated with Mock or AxCEACD/5-FC (P < 0.01). These results suggested that application of the Cre/loxP system could provide a new approach for enhanced selective suicide gene therapy of CD/5-FC for the treatment of advanced gastric carcinoma.
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